For a disease which (to my knowledge) can’t be slowed down or reversed, I think it’s a fair question why we would want to detect Alzheimer’s. Maybe there are other reasons, but my suspicion is that we will be able to, and an easy detection method significantly widens the pool of subjects to study later on.
If it turns out that driving a Prius on Tuesdays slows down Alzheimer’s, a larger pool of subjects would allow us to figure that out.
I would personally want to know as early as possible, so I could get my affairs in order and register my wishes around end of life care and euthanasia while I am still recognised as having full mental capacity.
It's also better for people around the Alzheimer's patient, as it will let them understand why someone's personality and behaviours may be changing, and possibly let them be bit more forgiving of such changes. It will also give family more time to plan and understand the health and community services and support are offered wherever they live.
> I would personally want to know as early as possible, so I could get my affairs in order and register my wishes around end of life care and euthanasia while I am still recognised as having full mental capacity.
Everyone should assume that they could lose their full mental capacity at any moment. Strokes, brain injuries, etc. can occur at any age with no warning.
My wife and I finally went through the entire estate planning process several years ago. It was comforting to know that we had a plan for a myriad of scenarios (including the incredibly depressing decision of where our assets would go if our entire family—us and our kids—was gone at the same time).
I know two people who have been taking the new monoclonal antibody treatment for it. One who was a bit further along when she started, and did not show any significant improvement. The one who started while she was still in the early stages has completely arrested her descent. She hasn't recovered much of what she already lost, but she's still able to live independently and enjoy life, and her mental acuity scores are (slightly) better than they were last year. That's a hell of a thing.
I also know someone who's significantly better now than they were a few years ago thanks to alzheimer's medication. And Trontinemab, which is currently in phase III trials I believe, seems even better than what is publicly available as it crosses the blood-brain barrier more readily. We're entering a brighter future for alzheimer's patients.
Completely arrested? I don't. But it appears to be arrested in ways that matter for mental acuity, for now. I've taken care of a parent with Alzheimer's, and helped several other caregivers over the years with their own family's journeys, and one thing I can tell you is that I have never, ever seen an actual halting of the progression for this long. The descent is usually a stairstep pattern, but the steps are on the matter of weeks to a month or two. My friend has been stable for a year.
This is all new. There is research hinting at Alzheimer's subtypes, some of which are more likely to respond than others. Even halting the decline is a huge potential breakthrough.
That's 4–6 months in the 18 months the trials lasted for, i.e. about a 30% slowdown of progression. The open-label extensions suggest this relative slowdown seems to continue at least to the 4-year mark (at which point it would have bought you over a year of time): https://www.alzforum.org/news/conference-coverage/signs-last...
Time will tell if the 30% slowdown continues beyond four years, and/or if earlier treatment with more effective amyloid clearance from newer drugs has greater effects. The science suggests it should.
The way I’ve watched Alzheimer’s work in a family member is that it’s a step down function rather than gradual. And once something is lost, it doesn’t come back. So anything that can delay the next step even just for months is a win right now.
It's very useful to understand what you're struggling from even if it's not curable. It explains your symptoms, your experience and help you understand what you're going through. Understanding that you're suffering from something incurable is also helpful in not looking for other ineffective methods to cure a mysterious illness.
Most people get a dementia (or related) diagnosis after they are deep enough in it so that they cant do much about it or get their affairs in order.
My grandfather had a "fall" at work, he then left that job, and held down 2 more engineering jobs before he was diagnosed with a stroking condition and subsequent dementia. I got the distinct impression he thought he had more time, but rapidly declined.
If he knew he was short of time before his rapid decline he probably would have done things differently. Like not buying a house he would later have to sell to pay for aged care.
If he knew he was at risk of a workplace accident he probably wouldn't have worked as an after hours safety engineer at a major treatment plant, where if the worst had happened he could have endangered others.
At a personal level, I've been through this with my grandfather.
I want to know. My family wants to know. I want to prepare because there are things I want to do today that I know I won't be able to do in the future.
In many ways, it's just like many terminal cancer diagnoses. You're going to lose that person, but you have some time.
But it is a wildly variated, almost meaningless diagnosis. 3 of my 4 grandparents got Alzheimer's diagnosis as well as my mom and mother-in-law. The variation of progression and symptoms is so wide that it really seems like a catch-all. One grandmother was fine until about 72 and in 2 years forgot who people were and 4 years had lost all executive function and passed away. The other one was diagnosed in her early 80s and lived to be 96 with no major progression, like slightly more repeating, but never forgetting people or not knowing how to talk etc. Similar dichotomy between my mother and mother-in-law but with considerably different presentations of symptoms.
It's a weird disease and IMO not even really a disease it's a bunch of different causes of cognitive impairment under one umbrella but shouldn't be separated out much further to find actual causes and treatments.
The accuracy of this test is nowhere nearly good enough to do population-wide screening. The clinical setting for this test is memory clinics in which Alzheimers is already relatively highly likely differentially, and even there you're going to get a surprising number of false positives.
(There's enough info in the supplemental link on this page to have an LLM do the Bayes math for you.)
> doctors correctly diagnosed Alzheimer's in 75.5% of cases, but when incorporating blood test results, diagnostic accuracy increased to 94.5%
These patients are already seeing doctors. Would you rather your doctor to hide the diagnosis just because your disease isn't curable (for now)? It's not like we're testing the whole population in masse.
Even though it cannot be reversed or eradicated (yet, let's hope) detection can allow individuals to adopt interventions that help either adjust their lives to better cope with its progression or help mitigate some of the detrimental behavioral consequences. In addition, if you have family to care for it may be impetus to get certain things in order for them before later stages of the disease, etc. It's horrible and bleak, but I could certainly see why one might want to know.
In the lucky case, it can also relieve anxiety. Even though false negatives may still be possible, receiving a negative detection might give people who have anxiety about certain symptoms relief, since they can rule out (rightly or wrongly) a pretty severe disease.
Being able to know someone's risk factor would be important for how we treat elderly people. I know someone who is 85 and super sharp (previously worked as a corporate accountant and banker), they still have a better memory than a lot of 40-50 year olds, and yet they are constantly harassed by eldercare "agents" for the state because whenever they make a investment decision that is even slightly questionable they get reported to the state by the bank. Sometimes the bank refuses to authorize transactions. If they could conclusively prove they aren't at risk I think they would be left alone much more often.
If a loved one is suffering from this, this diagnostic would allow for interventions such as guardianship to assume financial and logistical responsibility for them with less subjective decisioning based on observations alone.
If the patient still has periods of lucidity but the disease is suspected to be advancing, knowing they have it could prompt them to get their legal affairs in order.
> For a disease which (to my knowledge) can’t be slowed down or reversed, I think it’s a fair question why we would want to detect Alzheimer’s. Maybe there are other reasons, but my suspicion is that we will be able to, and an easy detection method significantly widens the pool of subjects to study later on.
Your point at the end is essentially correct. There's a couple of reasons that come to my mind:
Early detection lets us test cures more quickly. You can see if the treatment is working without waiting 30 years for symptoms to develop or not. If prevention is all that works, we can verify lifestyle changes, again without having to wait 30 years for symptoms to develop.
Early detection means there's more of a chance of any future treatment succeeding and the patient returning to a normal life. Think of early detection of cancer or heart disease meaning you can be treated with less risky medication and procedures and minimise the damage being done.
I assume this is hugely beneficial for research on intervention methods, not for treatment. I think everyone is focusing on "I'd rather know" but imagine if you could get larger populations with a diagnosis earlier on, how impactful that would be for testing an intervention?
Look up some of the more recent treatments - many of which will get better with time. That's why detecting Alzheimer's early is a big deal
https://en.wikipedia.org/wiki/Lecanemab
To rule out Alzheimers when you wonder whether your recent episodes of forgetfulness have an underlying medical cause.
That aside, some moderately effective drugs have recently been approved that can slow down the disease in its early stages. And even if you are no candidate for these: you can start organising the life around you while you still can. Like moving to an assisted living facility.
Having struggled with hard to diagnose health issues before, I can’t emphasize enough how much of a relief it is to put a name on the disease that is causing you so much harm.
It is frankly shocking to think disease diagnosis would be a useless thing
Not saying anything about the article at-hand, but assuming we were able to detect it with such certainty, I think it would greatly increase the funding, rigor, and breadth or research devoted to finding a cure or treatment that actually worked.
For 20-ish% of Alzheimer's patients, the Shingles vaccine may be a treatment. This has been suspected for a few years now but has received recent confirmation studies.
While the study was about the shingles vaccine, I wonder if having passed normally through shingles influences positively or negatively the chances of later developing Alzheimer's.
Nobody is ever going to do that with this test, because the overwhelming majority of positive test results in a population-wide sample will be false, and the proposed diagnosis is devastating. This is a test for people who already have symptomatic dementia that helps confirm the diagnosis.
Well this test isn't for whether you will get Alzheimer's, so that disqualifies it before we even consider the accuracy.
But apparently your odds go above 30% if you live long enough, so if you could test for being in that cohort I think that result would be too common to actually be devastating.
> Tell 50 million people they’re likely to have Alzheimer’s then tell them where to donate towards a cure, or treatments to slow it by a decade.
Pharmaceutical companies have spent something like $50 billion on developing Alzheimer's drugs with, well, the most furtive of straw-grasping to show for it. It's probably the most expensive single disease target (especially as things like cancer are families of diseases)... the failure to have good results isn't for lack of money, and merely throwing more money at it is unlikely to actually make progress towards meaningful treatments.
It just seems really obvious to me that it's not one disease. One problem with the research is that there is SO much money. It's corrupting. There's a whole thing about the plaque cartel and if you aren't testing around a possibly flawed concept the availability of funds is much lower.
I just feel the thinking is off, it's like we are trying to treat cuts by removing scabs and scar tissue. We really need deep investigation on the sources, which I feel in many cases are industrial chemicals and how some people's body / immune system respond to them.
One of the most compelling studies I saw was how distance from a Golf Course predicted neurodegenerative diseases, based on their use of certain pesticides.
I wonder if after services like 23andMe became popular and millions of people found out they have the Alzheimer genes, did donations towards brain research rise?
Trontinemab is in trials right now and has 92% of patients achieving low amyloid levels. And more people should be able to take it as it causes less brain swelling (ARIA-E). I'm unaffiliated, I just follow medical research in my free time. But I'm quite hopeful about this medication
I understand the "detect deadly progression but no cure" problem; this was the same rationale people used when Huntington disease could be verified in diagnostics. Many people don't want to know, but some want to know, in particular as you can manage some things here or there - diet affects many things, for instance, even aside from metaboic genetic defects. And for any (molecular) therapy at a later time you need to understand the molecular basis to some extent. Some things can be found out via trial and error (vaccination and before) but for some disease that can not work. Alzheimer is quite complex.
We have no cure now but that may change and depend on early detection just as taking meds now can slow the onset. I don’t want to know makes no sense to me. You would plan your whole life differently and it would actually be quite liberating once you’d come to terms with it.
If astronomers announced that a large asteroid might strike Earth in twenty years, and that we currently had no way to deflect it, nobody would respond by saying, “Come back when you already have the rocket.” We would immediately build better telescopes to track it precisely, refine its trajectory models, and begin developing propulsion systems capable of interception. You do not wait for the cure before improving the measurement. You improve the measurement so that a cure becomes possible, targeted, and effective.
Medicine is no different. Refusing to improve early, probabilistic diagnosis because today’s treatments are modest confuses sequence with outcome. Breakthroughs do not emerge from vague labels and mixed populations. They emerge from precise, quantitative stratification that allows real effects to be seen. The danger is not that we measure too early. It is that we continue making irreversible clinical and research decisions using imprecise, binary classifications while biological insight and therapeutic tools are advancing rapidly. Building the probabilistic layer now is not premature. It is how we make future intervention feasible.
This analogy has a rather fatal flaw, which is that we already know people who've gotten Alzheimer's, and we also know for a fact people will continue to fall victim to it, at a pretty predictable rate. i.e. the detection has already happened! Anyone who was waiting for a potential victim to appear before researching the cure already has all the reasons they need to research it. Detecting whom exactly the next victim is going to be isn't really going to change anything as far as researching a treatment or cure goes. (Unless the person is super important or popular or rich, I guess?)
This is absolutely nothing like the asteroid example, where knowing that anybody is going to fall victim to it would itself be news of astronomical proportions. Previously there was a high chance the event wouldn't happen, and now it seems likely it will, so that entirely change the calculus of your priorities.
This just completely destroys the analogy. (There are other reasons it doesn't fit too, but one is enough.)
The reason the test and actually knowing who is likely to develop the disease is useful is that we don't know enough about the early pre-symptomatic stages of Alzheimer's. A lot of research has been focused on purging the plaques which form in the late stages of the disease and thus failed because these seem to be symptomatic rather than causative. The false positives are also very interesting from a research point of view because if someone is testing positive for the disease but it's not progressing this may give us a clue about how to control it.
The other slightly sad fact is that is also quite likely that any curative treatment will need to be started before you start to show symptoms, because the brain has already lost a lot of it's resilience by then.
[testing positive for the disease but it's not progressing] -- Yes, exactly this. There are people with two copies of the bad APOE4 gene. 95% of them develop early-onset Alzheimer's in their 50s. The medical community is now very intensely studying the remaining 5% to find out what's causing them to NOT get sick.
Sloppy wording. -- Fortea (2024) -- Over 95% of people with two copies have amyloid beta in their cerebrospinal fluid. (not full-blown Alzheimers symptoms, just early detection)
> Detecting whom exactly the next victim is going to be isn't really going to change anything as far as researching a treatment or cure goes.
Your reasoning relies heavily on this statement, which is only true if occurrence is entirely random, which is in most cases not true. A condition can easily mask the cause of the condition and then you have a confounder(-s) that you have no way of controlling. If you can build multiple strata with high risk ratios, you can find baseline similarities and differences in those groups. Early detection is highly important in knowing these confounders in the first place and then controlling for; and as GP mentions allows for more targeted research in treatment. Without this we could easily spend all the research effort on the effect (symptom) of a condition without even approaching treatment of the cause, i.e. prevention.
A very similar thing has happened with the infamous atherosclerotic plaques. AFAIK (correct me if you are aware of any evidence) there is currently no mechanistic model of how these atherosclerotic plaques form. Yet we spend so much effort in lowering the symptomatic side of increased cholesterol/LDL (which has well-known positives) even if there are known metabolic pathways for LDL increase, based entirely on correlational studies, when LDL is not even close to being the best predictor of cardiovascular conditions. LDL just happens to be easy to measure in a blood test and easy to control with oral medication.
And even if occurrence was random, there might be effects that can only be measured early on. By identifying patients before the onset of serious symptoms we can get a much more comprehensive medical history than by only looking once the symptoms are bad enough to make Alzheimer's obvious, or by monitoring large strata of the population in hopes of including enough future Alzheimer's patients in the sample
Accurate detection in individuals is still important for testing any potential cure. Otherwise you can only do normal population studies over a very long time and pray that you didn't miss on any confounding variables. With this level of accuracy in diagnosing, you can do targeted testing.
While that is true, it doesn't change the sentiment behind “We have no cure. I don’t want to know.” if knowing the diagnosis doesn't help you personally. Sure you might have a sense of responsibility for mankind but you still know you can't do anything to save yourself.
With that said, lifestyle changes can slow down the onset of Alzheimer's, so knowing the diagnosis isn't totally useless.
A lot of people have enough of a sense of responsibility to donate blood, or donate their organs.
I've long had the suspicion that much of what is called Alzheimers or dementia is some form of prion disease. This study doesn't show that, exactly, but it shows that abnormal proteins may be directly correlated.
So - and I'm not saying this is the case - but suppose that the abnormal proteins identified in this study could be transmitted by blood transfusions or organ transplants. Wouldn't that itself be enough for your diagnosis to help you personally not transmit those proteins to someone else?
If your attitude is that no one else in the world matters once you get a bad diagnosis, then nothing really mattered to you before. Other people are working day and night trying to cure you, so there's no cause for that level of nihilism. You may as well try to help from the vantage point you have.
This is an incredibly short sighted, fragile-ego protecting, selfish instinct.
Making plans while you are cognizant is valuable, and the sooner you know, the longer and better plans you can make. Making plans with friends and family should be done sooner than later with these kinds of things.
It absolutely helps to personally to know, but people avoid emotional pain like the plague. So they delay and delay and then the emotional pain is amplified anyway when things come to ahead. It really is better to rip that band-aid off sooner... I think.
Maybe it is, and I'm not saying that's how I think. I would prefer to know the diagnosis. But that's not necessarily how everyone, or even most people, would act. So what if this is fragile ego and selfish? Are people not allowed to be weak, selfish?
In a case like this, it is possible and even substantially likely that a "Cure" represents a treatment you can apply after an early, routine blood test but before clinically significant symptoms arise, to prevent damage from becoming significant enough to represent an illness.
Late-stage Alzheimers', if not every stage, is very likely going to involve microscopic-scale physical damage to brain tissue that is functionally irreversible.
Blowing up an asteroid after you can see it in the sky with your naked eye will not save you.
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It is also possible that what we call "Alzheimers" is actually biochemically five different disorders with distinct etiologies that have the same endpoint, and that it turns out we can cure two of them. Differentiating conditions for a biomedical catch-all category would be essential; "How accurate you can get the tests" is inseparable from this process of definition.
It may not change much as far as researching a treatment or cure goes, but it may help with other stuff, like being better prepared for the future, like organizing a health care worker or getting family members to help out or to look out for you, and other stuff, which you might not be able to do at a later stage of Alzheimers.
While there aren't any cures yet, certain treatments and lifestyle strategies may slow its progression, keep quality of life as long as possible and stuff like that for as long as possible. (And the sooner you start with that, the better)
More information is not always better for the patient. If you could detect the disease 5 years before symptoms began, there are certain psychological harms that come with that knowledge. These must be balanced against the things you mention about "slowing" the disease (unclear if any treatments do much for a given individual) and planning your future. You talk about quality of life, but quality of life declines the MOMENT you learn that you have a progressive, incurable, disease that will slowly rob you of your mind. It's not clear at all that knowing about your disease earlier is actually better for anyone.
I understand the concern about anxiety about their impending condition, but medical providers must not paternalistically decide to withhold a diagnosis from patients, at least not in all cases.
If I got an early diagnosis, it would motivate me to get my affairs in order to lessen the burden on my family and check off some bucket list items before it's too late. Don't rob me of that opportunity.
Before ordering the test, ask patients "If you were going to get Alzheimer's, would you want to know?"
>Detecting whom exactly the next victim is going to be isn't really going to change anything
What if you found for example all the diagnoses happened shortly after an HSV-1 infection? The more information as to what's going on the better, for research at any rate.
If you know they’re going to have it twenty years early, then you can try out preventative treatments. You can look at causes. You can get them to put power of attorney in place and prepare for their future.
Why are you so furious about the idea of people knowing?
No one is furious, but it is well established in epidemiology that more knowledge is not necessarily better for the patient. There are psychological harms that occur from the moment you learn that you have a disease that will slowly rob you of your mind. In general, you want fewer harms in your life.
Not really. Alzheimer's is about 60% of dementia, and is frequently misdiagnosed without a full workup. As primary care shifts to more poorly trained providers and doc in the box delivery models, you'll get less workups and more misdiagnoses.
A more objective blood test will make for more accurate diagnoses and and better treatment.
> If astronomers announced that a large asteroid might strike Earth in twenty years, and that we currently had no way to deflect it, nobody would respond by saying, “Come back when you already have the rocket.”
I don’t think the analogy fits, for a couple reasons.
1. People not wanting to know whether they have Alzheimer’s is because of the fear of a fate worse than death — living with Alzheimer’s.
2. People not wanting to know whether they have Alzheimer’s is not the same was not wanting a way to detect it. As you said, being able to measure it may help lead to a cure/treatment. I doubt people are against improving detection — they may just not want the detection to be applied personally.
Cure is the wrong word. Alzheimer’s can be best described as a failure of a system and "debris" accumulates faster than it can be "cleared". There are many moving parts and everyone is unique about the cause of their system failure.
Wrote up my current systems understanding here https://metamagic.substack.com/p/the-alzheimers-equation, but it makes clear why treatments that target only one variable are mathematically doomed to fail to work on everyone and why there will never be a single "cure". It explains without needing to read 10,000 papers why we keep getting research talking about treatment X helps in some, but not all cases or symptom Y is associated in some, but not all, etc.
This is some personal opinion that I would bet the vast majority of Alzheimer's researchers would not actually agree with. The current consensus is that Alzheimer's is a particular disease, or a cluster of similar diseases.
I'm not saying your wrong, just that the level of confidence in your assertions is not warranted.
After spending years tracking through the genetics, conditions, lab work, research papers and seeing individuals years into the condition, this model is the best I have and explains everything I currently know. Why the cluster of conditions result in the same outcome, why some treatments help some folks, but not others.
But that is sort of the point of science, you take all the evidence you have and create a hypothesis and iterate as you get more evidence. If I find evidence that suggests something else then I will be happy to tweak or abandon this. My level of confidence comes from the existing evidence and lack of evidence otherwise.
Amateur's asserting their opinions as facts isn't great, but epistemologically it's no worse (and systemically, like less harmful) than when the experts do it.
Saying that experts are less likely to do X doesn't say anything about the relative harm of their doing so. If some rando on the streets is shouting their opinion about what causes Alzheimer's and asserting it's God's Own Truth, it's going to cause less overall harm that a carefully worded (but equally wrong) statement from an expert. (And the fact that we tend to hold experts in higher regard is the reason we should be more concerned about them stating their opinions as facts than about amateurs doing the same.)
Exactly - there are things that I would change now to make sure I make thing easier for myself and - more importantly - easier for the people around me.
I think there are many people (myself included) whose plans would change dramatically upon discovery of Alzheimer's, dementia, or some other degenerative disease. I might consider moving to somewhere with more liberal assisted suicide laws for example.
Notarizing any wishes against some medical procedures in case a sudden accident ruins your ability to dissent prevents doctors from being forced to keep your body alive as long as possible.
That doesn't apply to Alzheimer's disease directly though. If you don't want to live when your conscious life is limited to short flashes of awareness among a deeply terrifying melange of visions of the past and hallucinations, DNR laws don't in any way force or even allow doctors to euthanize you. You can persist in this state for many years without ever triggering a DNR check.
My genetics are such I'm more likely to drop dead of a heart attack too young.
If I were likely to develop alzheimer's, I'd make more and more expensive accommodation for power of attorney and trusts to shield assets while I was competent to do so.
Like what? You should already have a will, life insurance, etc. even without the disease. All you're doing by knowing earlier is causing psychological harms to yourself and the people you tell, adding more years of anxiety, grief, and sadness for no gain. Think about the bigger picture.
These are 50yos, not elderly retirees. What if knowing caused your employer to deny you a promotion? Im in the military. This sort of diagnosis on one's file could have real impact on future prospects. People already fear ADHD tests for the same reason. I know a guy who is leaving the military after 20+ years flying transports. He is applying to airlines. If you were an airline, would you higher an experienced pilot with a positive alzheimer's diagnois in thier medical data?
>Refusing to improve early, probabilistic diagnosis because today’s treatments are modest confuses sequence with outcome.
While you're right from the perspective of humanity taking the steps of gathering data then tackling the disease, most developed countries have single payer healthcare systems that require some level of cost-benefit analysis to approve covering new diagnostic systems.
Alzheimer's disease progression doesn't seem to have any notable preventative indications other than 'eat well, exercise and stay mentally active', all of which are standard recommendations.
Recall that this isn't an issue deciding between funding and non-funding. It's an issue deciding between funding Alzheimer's diagnostics, new GMP agonists, new screening options for highly preventable cancers, etc. Building out a dataset is nice but unless that's surplus money redirected from other programs it's going to come at a real flesh and blood cost.
Alzheimer isn't new. You should compare it with a situation like:
Imagine you're born and you eventually learn that there's an asteroid on a collision course with earth, from way before you were born. It's going to take many years to get here and you may die before it hits and so far no scientists have been able to come up with a way to deflect it. Do you care?
Adding newness to the situation makes it wildly different.
Okay but even that analogy is limited. Incurable progressive diseases almost invariably have lifestyle factors, supplements, or medications that can at least slow the rate of progression for many people. Those are also often more effective when started during early stage detection. There is literally nothing the average person can do about the asteroid.
Absolutely, the belief in scientific circles is that the way forward to develop cures (or at least treatment that slows down the progression) is to treat it early. When you get to the point where you start showing clear symptoms, your brain is already mush. If you have a potential treatment that attacks the root cause, you would have to catch the very early, pre-clinical, stages of the disease, but without good diagnostics there is no way to do that (short of giving the disease to a wide swath of the population, like a vaccine... but that gets expensive very quickly, and side effects become a bigger worry.
> We would immediately build better telescopes to track it precisely, refine its trajectory models, and begin developing propulsion systems capable of interception
That's not what would happen. We wouldn't mobilize. We'd fragment. Within days, the prediction would be declared partisan. One bloc would call it settled science; another would call it statistical hysteria. Billionaires would quietly commission private shelters while publicly funding studies questioning whether the asteroid even qualified as "large." News panels would debate whether the projected impact zone was being unfairly politicized. Conspiracy channels would insist the asteroid was fabricated to justify global governance. Others would insist the real asteroid was being hidden. Amateur analysts would flood the internet with homemade trajectory charts proving the professionals wrong. Death threats would arrive in astronomers' inboxes faster than research grants.
Maybe if you can keep the results a secret from health insurance companies you’d have a point. However, not everyone has coverage under a large organization’s umbrella, and these people might be denied coverage.
“We have no cure. I don’t want to know.” isn’t the same as “We have no cure. We as a society don’t want to know.”
People can be fine with being tested so that epidemiologists can work on growing our knowledge and, at the same time, not wanting to know their own diagnosis.
That's a hypothesis. If we knew that for certain, it would be really big news; and we could investigate to learn why, and then we could isolate the causative factors and perhaps find other ways of deploying them… If you know something the rest of us don't, prove it: show us the evidence, show us the specific hypotheses, describe a repeatable experiment, show us the results if such an experiment has been performed.
If you don't know something the rest of us don't, don't be so arrogant about your pet theories. Such arrogance costs lives.
You do realize they already are investigating, right? Even looking into MS and parkinson. ALZHEIMER’S DISEASE (AD) and AD DEMENTIA
Umbrella review (systematic reviews of SRs):
https://www.nature.com/articles/s44400-025-00048-6
> You do realize they already are investigating, right?
Yes. I also realise they have not reached the conclusion of this investigation. (Imagine this attitude towards a police investigation: "They're investigating Roger Rabbit, therefore he must have dunnit!")
A detail, but an important one: the blood test brought the initial diagnosis closer to the final one. The result reflects the agreement between both diagnoses. The usefulness of the blood test depends on the quality of the final diagnosis, which can still be wrong.
PSA to those with family affected by dementia/Alzheimer's at a relatively early age (say <70yo): Get them tested for STDs, specifically Syphilis.
Left untreated for a very long time (decade+), it spreads to the brain and causes dementia among other things. Older generations with stigmas, taboos, or from lower educational backgrounds seem (to me) less likely to get tested, so it seems plausible.
Source: Have recently discovered this myself with a family member from their neurologist.
> Source: Have recently discovered this myself with a family member from their neurologist.
The reason this was detected is that such testing is a standard practice with new dementia patients—among many other tests that identify etiologies of dementia.
> Definitely not the case, not in all regions, not even within the same country
Perhaps—but it's also possible that whoever was in the room with the patient declined STI testing (which I have seen, and which sometimes reflects lack of knowledge around extramarital affairs).
I'm just trying to make it clear that there are dozens of reversible/non-degenerative causes of dementia and there is no way that a fully-trained neurologist doesn't have these memorized.
It's like not knowing what a type system is as a programmer with a reputable degree—impossible.
edit: in fairness, many doctors have unease around discussing sex/infidelity—but the PSA maybe should be to encourage your doctor to put aside concerns around niceties in your parent's care.
He was shot in 1918 leaving bullets in his body and left him weakened, then in 1922 he suffered at least three debilitating strokes. He lost his ability so speak and had to learn to speak again. He even proposed assisted suicide because he was suffering so much. He then had a final fatal stroke in 1924. I don't think "he looks crazy so he must have had some STD" is medically accurate or remotely appropriate on what's supposed to be an academic forum. He most likely had brain damage towards the end thus his illness of course was reflected on his body looked. Lenin's eyes reflected his post-stroke damage.
He was quite sane in his life and his work expanding on Marx is of course extremely important.
that doesn't bother me but what is actually suspicious is persistently only mentioning "accuracy" but not sensitivity / specificity / precision etc.
Basically, almost everybody doesn't have Alzheimers. Sampling from the general population you can get better than 94.5% accuracy just by returning negative on every test. You have to know sensitivity and specificity separately to make any informed judgement ... which they try extremely hard not to tell you.
> Compared with the final diagnosis, the pre-biomarker diagnosis was maintained in 71/200 cases (75.5%) (Kappa = 0.576), while the post-biomarker diagnosis was maintained in 189/200 cases (94.5%) (Kappa = 0.906).
Even without this method, the doctors have been able to give diagnosis with 75.5% accuracy (according to the paper's claim).
I.e. it needs the original 75% accuracy or so and boosts it another 20%.
The problem is that the assessment itself is slow, expensive and requires skill.
What we really want from a test is high specificity (a positive test means you have accuracy) and high sensitivity (if you get a negative test you don't have it).
Maybe I've misunderstood something, but how can they know the accuracy of the test? It is the best test out there, so if it misses a diagnosis, how do they reliably catch the false negative?
Besides being a bad joke, this is in terrible taste on a thread read by people with Alzheimer's patients in their lives, and it violates HN's rules that discussion should be valuable and inspire curiosity.
One of interesting checks in this study might be to check when (if) any of the participants had taken this vax and what the impact might be on an Alzimer's diagnosis.
Purely anecdotal, but I witnessed a person starting to experience a severe cognitive decline right after the two doses of the Shingles Vaccine. It can surely be a coincidence, but I was very surprised when I read about this study.
This needs to include life-changing false positive rates. Imagine being given a diagnosis like this - people around you who know and any corporations who can sniff it out by snooping on your communications can lead to much rejection early in life. What happens when the diagnosis is as positive when it shouldn’t have been?
https://doi.org/10.1038/s41591-025-03622-w this is the paper they're basing the research on. So in primary care, the accuracy rates are in the 80s. So that's something like a 17% false positive rate. That's still like 5 to 1 odds of getting a correct result though. It's much better than nothing.
Sorry, but the test hasn't been shown to be 94.5% accurate. The study was structured as: 1. neurologist makes clinical diagnosis using usual tools and records most likely diagnosis and their confidence in it 2. new p-tau test is done. 3. neurologists reassess their confidence, and change their mind in many cases. There is no "gold standard" here (tough to have in AD) and not even a period of clinical follow-up to assess for any interval change. The study shows that patients got reclassified, but never showed that such reclassification was more accurate than the initial one, and by how much. There is an implication that because in a different, retrospective study the test did show some accuracy, that it would be helpful in this new situation. But that's about it, and different than directly showing this to be the case.
I got bad news about the specificity for most things this serious. Think the only one we absolutely nail is infectious disease detection.
Spoilers: It's anywhere between 1-15 and 5-30% for false positives and 1-15/5-40 for false negatives. That's imaging, biomarkers, cancer screenings, etc
Like, where do you think the concept of "second opinions" came from? Whimsy? Lets go ask a second doctor if I actually have cancer, it'll be fun!
This statement is quite broad and misses several important factors.
First of all, a test's sensitivity and specificity. The math in your example assumes a balanced test, but on what basis? The math comes out quite different for high-sensitivity or high-specificity tests. (Unfortunately, I could not find the numbers for the test in the linked article.)
Secondly, whom are we testing? The prevalence rate in your example (1%) is unrealistically low even for the general population. But would we screen the general population? No, we'd screen high-risk groups: the elderly, those with certain APOE genotypes etc. Predictive values of a test depend hugely on the prevalence rate.
Lastly, it depends on how the results are used. If it's a high-sensitivity test used to decide whom to send to the next tier in a multi-tier diagnostic system, it could actually be quite effective at that (very rarely missing the disease while greatly reducing the need for more expensive or more invasive testing).
For a disease which (to my knowledge) can’t be slowed down or reversed, I think it’s a fair question why we would want to detect Alzheimer’s. Maybe there are other reasons, but my suspicion is that we will be able to, and an easy detection method significantly widens the pool of subjects to study later on.
If it turns out that driving a Prius on Tuesdays slows down Alzheimer’s, a larger pool of subjects would allow us to figure that out.
I would personally want to know as early as possible, so I could get my affairs in order and register my wishes around end of life care and euthanasia while I am still recognised as having full mental capacity.
It's also better for people around the Alzheimer's patient, as it will let them understand why someone's personality and behaviours may be changing, and possibly let them be bit more forgiving of such changes. It will also give family more time to plan and understand the health and community services and support are offered wherever they live.
> I would personally want to know as early as possible, so I could get my affairs in order and register my wishes around end of life care and euthanasia while I am still recognised as having full mental capacity.
Everyone should assume that they could lose their full mental capacity at any moment. Strokes, brain injuries, etc. can occur at any age with no warning.
My wife and I finally went through the entire estate planning process several years ago. It was comforting to know that we had a plan for a myriad of scenarios (including the incredibly depressing decision of where our assets would go if our entire family—us and our kids—was gone at the same time).
I know two people who have been taking the new monoclonal antibody treatment for it. One who was a bit further along when she started, and did not show any significant improvement. The one who started while she was still in the early stages has completely arrested her descent. She hasn't recovered much of what she already lost, but she's still able to live independently and enjoy life, and her mental acuity scores are (slightly) better than they were last year. That's a hell of a thing.
I also know someone who's significantly better now than they were a few years ago thanks to alzheimer's medication. And Trontinemab, which is currently in phase III trials I believe, seems even better than what is publicly available as it crosses the blood-brain barrier more readily. We're entering a brighter future for alzheimer's patients.
How do you know it's completely arrested?
Best these type of drugs can do is give you a few months extra window (say 4-6 months). They're not a cure. Sadly.
Completely arrested? I don't. But it appears to be arrested in ways that matter for mental acuity, for now. I've taken care of a parent with Alzheimer's, and helped several other caregivers over the years with their own family's journeys, and one thing I can tell you is that I have never, ever seen an actual halting of the progression for this long. The descent is usually a stairstep pattern, but the steps are on the matter of weeks to a month or two. My friend has been stable for a year.
This is all new. There is research hinting at Alzheimer's subtypes, some of which are more likely to respond than others. Even halting the decline is a huge potential breakthrough.
I hope there'll be a cure or something that lasts long. It's a horrible disease. Best of luck!
That's 4–6 months in the 18 months the trials lasted for, i.e. about a 30% slowdown of progression. The open-label extensions suggest this relative slowdown seems to continue at least to the 4-year mark (at which point it would have bought you over a year of time): https://www.alzforum.org/news/conference-coverage/signs-last...
Time will tell if the 30% slowdown continues beyond four years, and/or if earlier treatment with more effective amyloid clearance from newer drugs has greater effects. The science suggests it should.
The way I’ve watched Alzheimer’s work in a family member is that it’s a step down function rather than gradual. And once something is lost, it doesn’t come back. So anything that can delay the next step even just for months is a win right now.
They tell you this:
> her mental acuity scores are (slightly) better than they were last year
Wait what treatment is this?
Probably either lecanemab (older) or donanemab (newer).
In my friend's case, donanemab, FWIW.
It's very useful to understand what you're struggling from even if it's not curable. It explains your symptoms, your experience and help you understand what you're going through. Understanding that you're suffering from something incurable is also helpful in not looking for other ineffective methods to cure a mysterious illness.
Most people get a dementia (or related) diagnosis after they are deep enough in it so that they cant do much about it or get their affairs in order.
My grandfather had a "fall" at work, he then left that job, and held down 2 more engineering jobs before he was diagnosed with a stroking condition and subsequent dementia. I got the distinct impression he thought he had more time, but rapidly declined.
If he knew he was short of time before his rapid decline he probably would have done things differently. Like not buying a house he would later have to sell to pay for aged care.
If he knew he was at risk of a workplace accident he probably wouldn't have worked as an after hours safety engineer at a major treatment plant, where if the worst had happened he could have endangered others.
> why we would want to detect Alzheimer’s
At a personal level, I've been through this with my grandfather.
I want to know. My family wants to know. I want to prepare because there are things I want to do today that I know I won't be able to do in the future.
In many ways, it's just like many terminal cancer diagnoses. You're going to lose that person, but you have some time.
But it is a wildly variated, almost meaningless diagnosis. 3 of my 4 grandparents got Alzheimer's diagnosis as well as my mom and mother-in-law. The variation of progression and symptoms is so wide that it really seems like a catch-all. One grandmother was fine until about 72 and in 2 years forgot who people were and 4 years had lost all executive function and passed away. The other one was diagnosed in her early 80s and lived to be 96 with no major progression, like slightly more repeating, but never forgetting people or not knowing how to talk etc. Similar dichotomy between my mother and mother-in-law but with considerably different presentations of symptoms.
It's a weird disease and IMO not even really a disease it's a bunch of different causes of cognitive impairment under one umbrella but shouldn't be separated out much further to find actual causes and treatments.
The accuracy of this test is nowhere nearly good enough to do population-wide screening. The clinical setting for this test is memory clinics in which Alzheimers is already relatively highly likely differentially, and even there you're going to get a surprising number of false positives.
(There's enough info in the supplemental link on this page to have an LLM do the Bayes math for you.)
Off-topic: I only came to this thread because I thought "I bet some comment will manage to somehow include LLMs in the discussion".
Looks like my prior was not too bad :)
> doctors correctly diagnosed Alzheimer's in 75.5% of cases, but when incorporating blood test results, diagnostic accuracy increased to 94.5%
These patients are already seeing doctors. Would you rather your doctor to hide the diagnosis just because your disease isn't curable (for now)? It's not like we're testing the whole population in masse.
There are more personal practical reasons too.
Even though it cannot be reversed or eradicated (yet, let's hope) detection can allow individuals to adopt interventions that help either adjust their lives to better cope with its progression or help mitigate some of the detrimental behavioral consequences. In addition, if you have family to care for it may be impetus to get certain things in order for them before later stages of the disease, etc. It's horrible and bleak, but I could certainly see why one might want to know.
In the lucky case, it can also relieve anxiety. Even though false negatives may still be possible, receiving a negative detection might give people who have anxiety about certain symptoms relief, since they can rule out (rightly or wrongly) a pretty severe disease.
Being able to know someone's risk factor would be important for how we treat elderly people. I know someone who is 85 and super sharp (previously worked as a corporate accountant and banker), they still have a better memory than a lot of 40-50 year olds, and yet they are constantly harassed by eldercare "agents" for the state because whenever they make a investment decision that is even slightly questionable they get reported to the state by the bank. Sometimes the bank refuses to authorize transactions. If they could conclusively prove they aren't at risk I think they would be left alone much more often.
If a loved one is suffering from this, this diagnostic would allow for interventions such as guardianship to assume financial and logistical responsibility for them with less subjective decisioning based on observations alone.
If the patient still has periods of lucidity but the disease is suspected to be advancing, knowing they have it could prompt them to get their legal affairs in order.
> For a disease which (to my knowledge) can’t be slowed down or reversed, I think it’s a fair question why we would want to detect Alzheimer’s. Maybe there are other reasons, but my suspicion is that we will be able to, and an easy detection method significantly widens the pool of subjects to study later on.
Your point at the end is essentially correct. There's a couple of reasons that come to my mind:
Early detection lets us test cures more quickly. You can see if the treatment is working without waiting 30 years for symptoms to develop or not. If prevention is all that works, we can verify lifestyle changes, again without having to wait 30 years for symptoms to develop.
Early detection means there's more of a chance of any future treatment succeeding and the patient returning to a normal life. Think of early detection of cancer or heart disease meaning you can be treated with less risky medication and procedures and minimise the damage being done.
> For a disease which (to my knowledge) can’t be slowed down or reversed, I think it’s a fair question why we would want to detect Alzheimer’s.
Getting an accurate diagnosis is always important. Cognitive decline could be caused by other problems, some of which are more treatable than others.
If this test came back negative it would suggest extra testing to rule out other conditions like a brain tumor or hydrocephalus.
I assume this is hugely beneficial for research on intervention methods, not for treatment. I think everyone is focusing on "I'd rather know" but imagine if you could get larger populations with a diagnosis earlier on, how impactful that would be for testing an intervention?
there are treatments that can help slow progression, especially if it's found early.
What are they? I've read about basic lifestyle suggestions (diet and exercise), but I consider that the baseline. What can be done beyond that?
Lots of good info here: https://pmc.ncbi.nlm.nih.gov/articles/PMC11771116/
Look up some of the more recent treatments - many of which will get better with time. That's why detecting Alzheimer's early is a big deal https://en.wikipedia.org/wiki/Lecanemab
To rule out Alzheimers when you wonder whether your recent episodes of forgetfulness have an underlying medical cause.
That aside, some moderately effective drugs have recently been approved that can slow down the disease in its early stages. And even if you are no candidate for these: you can start organising the life around you while you still can. Like moving to an assisted living facility.
Having struggled with hard to diagnose health issues before, I can’t emphasize enough how much of a relief it is to put a name on the disease that is causing you so much harm.
It is frankly shocking to think disease diagnosis would be a useless thing
Not saying anything about the article at-hand, but assuming we were able to detect it with such certainty, I think it would greatly increase the funding, rigor, and breadth or research devoted to finding a cure or treatment that actually worked.
For 20-ish% of Alzheimer's patients, the Shingles vaccine may be a treatment. This has been suspected for a few years now but has received recent confirmation studies.
https://www.alzheimers.org.uk/news/2025-11-18/promising-rese...
While the study was about the shingles vaccine, I wonder if having passed normally through shingles influences positively or negatively the chances of later developing Alzheimer's.
This again?
The test is optional. Feel free to skip it.
Tell 50 million people they’re likely to have Alzheimer’s then tell them where to donate towards a cure, or treatments to slow it by a decade.
Nobody is ever going to do that with this test, because the overwhelming majority of positive test results in a population-wide sample will be false, and the proposed diagnosis is devastating. This is a test for people who already have symptomatic dementia that helps confirm the diagnosis.
Well this test isn't for whether you will get Alzheimer's, so that disqualifies it before we even consider the accuracy.
But apparently your odds go above 30% if you live long enough, so if you could test for being in that cohort I think that result would be too common to actually be devastating.
> Tell 50 million people they’re likely to have Alzheimer’s then tell them where to donate towards a cure, or treatments to slow it by a decade.
Pharmaceutical companies have spent something like $50 billion on developing Alzheimer's drugs with, well, the most furtive of straw-grasping to show for it. It's probably the most expensive single disease target (especially as things like cancer are families of diseases)... the failure to have good results isn't for lack of money, and merely throwing more money at it is unlikely to actually make progress towards meaningful treatments.
It just seems really obvious to me that it's not one disease. One problem with the research is that there is SO much money. It's corrupting. There's a whole thing about the plaque cartel and if you aren't testing around a possibly flawed concept the availability of funds is much lower.
I just feel the thinking is off, it's like we are trying to treat cuts by removing scabs and scar tissue. We really need deep investigation on the sources, which I feel in many cases are industrial chemicals and how some people's body / immune system respond to them.
One of the most compelling studies I saw was how distance from a Golf Course predicted neurodegenerative diseases, based on their use of certain pesticides.
So, you’re saying it’s an unsolvable problem?
Someone always says “merely throwing money at the problem…”
What time period was the money spent? The last 25 years?
The United States spends $1 trillion a year in debt interest. $50 billion is nothing
I wonder if after services like 23andMe became popular and millions of people found out they have the Alzheimer genes, did donations towards brain research rise?
Well, the AI CEOs are telling we will have AGI in ~5 years, so with millions of agents with AGI this thing should be sorted soon ;)
> For a disease which (to my knowledge) can’t be slowed down or reversed
There's Lecanemab and Donanemab. The effects are modest however.
Trontinemab is in trials right now and has 92% of patients achieving low amyloid levels. And more people should be able to take it as it causes less brain swelling (ARIA-E). I'm unaffiliated, I just follow medical research in my free time. But I'm quite hopeful about this medication
Even without a cure, there's still a lot of practical value in knowing earlier
This disease is in my family, honestly not sure I would want to know if I will get it.
I understand the "detect deadly progression but no cure" problem; this was the same rationale people used when Huntington disease could be verified in diagnostics. Many people don't want to know, but some want to know, in particular as you can manage some things here or there - diet affects many things, for instance, even aside from metaboic genetic defects. And for any (molecular) therapy at a later time you need to understand the molecular basis to some extent. Some things can be found out via trial and error (vaccination and before) but for some disease that can not work. Alzheimer is quite complex.
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We have no cure now but that may change and depend on early detection just as taking meds now can slow the onset. I don’t want to know makes no sense to me. You would plan your whole life differently and it would actually be quite liberating once you’d come to terms with it.
“We have no cure. I don’t want to know.”
If astronomers announced that a large asteroid might strike Earth in twenty years, and that we currently had no way to deflect it, nobody would respond by saying, “Come back when you already have the rocket.” We would immediately build better telescopes to track it precisely, refine its trajectory models, and begin developing propulsion systems capable of interception. You do not wait for the cure before improving the measurement. You improve the measurement so that a cure becomes possible, targeted, and effective.
Medicine is no different. Refusing to improve early, probabilistic diagnosis because today’s treatments are modest confuses sequence with outcome. Breakthroughs do not emerge from vague labels and mixed populations. They emerge from precise, quantitative stratification that allows real effects to be seen. The danger is not that we measure too early. It is that we continue making irreversible clinical and research decisions using imprecise, binary classifications while biological insight and therapeutic tools are advancing rapidly. Building the probabilistic layer now is not premature. It is how we make future intervention feasible.
This analogy has a rather fatal flaw, which is that we already know people who've gotten Alzheimer's, and we also know for a fact people will continue to fall victim to it, at a pretty predictable rate. i.e. the detection has already happened! Anyone who was waiting for a potential victim to appear before researching the cure already has all the reasons they need to research it. Detecting whom exactly the next victim is going to be isn't really going to change anything as far as researching a treatment or cure goes. (Unless the person is super important or popular or rich, I guess?)
This is absolutely nothing like the asteroid example, where knowing that anybody is going to fall victim to it would itself be news of astronomical proportions. Previously there was a high chance the event wouldn't happen, and now it seems likely it will, so that entirely change the calculus of your priorities.
This just completely destroys the analogy. (There are other reasons it doesn't fit too, but one is enough.)
The reason the test and actually knowing who is likely to develop the disease is useful is that we don't know enough about the early pre-symptomatic stages of Alzheimer's. A lot of research has been focused on purging the plaques which form in the late stages of the disease and thus failed because these seem to be symptomatic rather than causative. The false positives are also very interesting from a research point of view because if someone is testing positive for the disease but it's not progressing this may give us a clue about how to control it.
The other slightly sad fact is that is also quite likely that any curative treatment will need to be started before you start to show symptoms, because the brain has already lost a lot of it's resilience by then.
[testing positive for the disease but it's not progressing] -- Yes, exactly this. There are people with two copies of the bad APOE4 gene. 95% of them develop early-onset Alzheimer's in their 50s. The medical community is now very intensely studying the remaining 5% to find out what's causing them to NOT get sick.
Can you provide the source for the 95% figure?
Sloppy wording. -- Fortea (2024) -- Over 95% of people with two copies have amyloid beta in their cerebrospinal fluid. (not full-blown Alzheimers symptoms, just early detection)
https://www.theguardian.com/society/article/2024/may/06/scie...
> Detecting whom exactly the next victim is going to be isn't really going to change anything as far as researching a treatment or cure goes.
Your reasoning relies heavily on this statement, which is only true if occurrence is entirely random, which is in most cases not true. A condition can easily mask the cause of the condition and then you have a confounder(-s) that you have no way of controlling. If you can build multiple strata with high risk ratios, you can find baseline similarities and differences in those groups. Early detection is highly important in knowing these confounders in the first place and then controlling for; and as GP mentions allows for more targeted research in treatment. Without this we could easily spend all the research effort on the effect (symptom) of a condition without even approaching treatment of the cause, i.e. prevention.
A very similar thing has happened with the infamous atherosclerotic plaques. AFAIK (correct me if you are aware of any evidence) there is currently no mechanistic model of how these atherosclerotic plaques form. Yet we spend so much effort in lowering the symptomatic side of increased cholesterol/LDL (which has well-known positives) even if there are known metabolic pathways for LDL increase, based entirely on correlational studies, when LDL is not even close to being the best predictor of cardiovascular conditions. LDL just happens to be easy to measure in a blood test and easy to control with oral medication.
And even if occurrence was random, there might be effects that can only be measured early on. By identifying patients before the onset of serious symptoms we can get a much more comprehensive medical history than by only looking once the symptoms are bad enough to make Alzheimer's obvious, or by monitoring large strata of the population in hopes of including enough future Alzheimer's patients in the sample
Not to sound like an LLM, but what else can I say—you're absolutely right!
Accurate detection in individuals is still important for testing any potential cure. Otherwise you can only do normal population studies over a very long time and pray that you didn't miss on any confounding variables. With this level of accuracy in diagnosing, you can do targeted testing.
While that is true, it doesn't change the sentiment behind “We have no cure. I don’t want to know.” if knowing the diagnosis doesn't help you personally. Sure you might have a sense of responsibility for mankind but you still know you can't do anything to save yourself.
With that said, lifestyle changes can slow down the onset of Alzheimer's, so knowing the diagnosis isn't totally useless.
A lot of people have enough of a sense of responsibility to donate blood, or donate their organs.
I've long had the suspicion that much of what is called Alzheimers or dementia is some form of prion disease. This study doesn't show that, exactly, but it shows that abnormal proteins may be directly correlated.
So - and I'm not saying this is the case - but suppose that the abnormal proteins identified in this study could be transmitted by blood transfusions or organ transplants. Wouldn't that itself be enough for your diagnosis to help you personally not transmit those proteins to someone else?
If your attitude is that no one else in the world matters once you get a bad diagnosis, then nothing really mattered to you before. Other people are working day and night trying to cure you, so there's no cause for that level of nihilism. You may as well try to help from the vantage point you have.
> We have no cure. I don’t want to know.
This is an incredibly short sighted, fragile-ego protecting, selfish instinct.
Making plans while you are cognizant is valuable, and the sooner you know, the longer and better plans you can make. Making plans with friends and family should be done sooner than later with these kinds of things.
It absolutely helps to personally to know, but people avoid emotional pain like the plague. So they delay and delay and then the emotional pain is amplified anyway when things come to ahead. It really is better to rip that band-aid off sooner... I think.
Maybe it is, and I'm not saying that's how I think. I would prefer to know the diagnosis. But that's not necessarily how everyone, or even most people, would act. So what if this is fragile ego and selfish? Are people not allowed to be weak, selfish?
In a case like this, it is possible and even substantially likely that a "Cure" represents a treatment you can apply after an early, routine blood test but before clinically significant symptoms arise, to prevent damage from becoming significant enough to represent an illness.
Late-stage Alzheimers', if not every stage, is very likely going to involve microscopic-scale physical damage to brain tissue that is functionally irreversible.
Blowing up an asteroid after you can see it in the sky with your naked eye will not save you.
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It is also possible that what we call "Alzheimers" is actually biochemically five different disorders with distinct etiologies that have the same endpoint, and that it turns out we can cure two of them. Differentiating conditions for a biomedical catch-all category would be essential; "How accurate you can get the tests" is inseparable from this process of definition.
It may not change much as far as researching a treatment or cure goes, but it may help with other stuff, like being better prepared for the future, like organizing a health care worker or getting family members to help out or to look out for you, and other stuff, which you might not be able to do at a later stage of Alzheimers.
While there aren't any cures yet, certain treatments and lifestyle strategies may slow its progression, keep quality of life as long as possible and stuff like that for as long as possible. (And the sooner you start with that, the better)
More information is not always better for the patient. If you could detect the disease 5 years before symptoms began, there are certain psychological harms that come with that knowledge. These must be balanced against the things you mention about "slowing" the disease (unclear if any treatments do much for a given individual) and planning your future. You talk about quality of life, but quality of life declines the MOMENT you learn that you have a progressive, incurable, disease that will slowly rob you of your mind. It's not clear at all that knowing about your disease earlier is actually better for anyone.
I understand the concern about anxiety about their impending condition, but medical providers must not paternalistically decide to withhold a diagnosis from patients, at least not in all cases.
If I got an early diagnosis, it would motivate me to get my affairs in order to lessen the burden on my family and check off some bucket list items before it's too late. Don't rob me of that opportunity.
Before ordering the test, ask patients "If you were going to get Alzheimer's, would you want to know?"
>Detecting whom exactly the next victim is going to be isn't really going to change anything
What if you found for example all the diagnoses happened shortly after an HSV-1 infection? The more information as to what's going on the better, for research at any rate.
It's less like discovering the asteroid exists, and more like refining its trajectory enough to know where and when to intercept it
Off topic: Would insurance companies carry patients after being detected for Alzheimers?
In the US or in countries with working healthcare?
If you know they’re going to have it twenty years early, then you can try out preventative treatments. You can look at causes. You can get them to put power of attorney in place and prepare for their future.
Why are you so furious about the idea of people knowing?
No one is furious, but it is well established in epidemiology that more knowledge is not necessarily better for the patient. There are psychological harms that occur from the moment you learn that you have a disease that will slowly rob you of your mind. In general, you want fewer harms in your life.
You don't see any harm in a disease slowly robbing your mind, while you are not warned, and so you waste the time you have left?
Not really. Alzheimer's is about 60% of dementia, and is frequently misdiagnosed without a full workup. As primary care shifts to more poorly trained providers and doc in the box delivery models, you'll get less workups and more misdiagnoses.
A more objective blood test will make for more accurate diagnoses and and better treatment.
> “We have no cure. I don’t want to know.”
> If astronomers announced that a large asteroid might strike Earth in twenty years, and that we currently had no way to deflect it, nobody would respond by saying, “Come back when you already have the rocket.”
I don’t think the analogy fits, for a couple reasons.
1. People not wanting to know whether they have Alzheimer’s is because of the fear of a fate worse than death — living with Alzheimer’s.
2. People not wanting to know whether they have Alzheimer’s is not the same was not wanting a way to detect it. As you said, being able to measure it may help lead to a cure/treatment. I doubt people are against improving detection — they may just not want the detection to be applied personally.
Cure is the wrong word. Alzheimer’s can be best described as a failure of a system and "debris" accumulates faster than it can be "cleared". There are many moving parts and everyone is unique about the cause of their system failure.
Wrote up my current systems understanding here https://metamagic.substack.com/p/the-alzheimers-equation, but it makes clear why treatments that target only one variable are mathematically doomed to fail to work on everyone and why there will never be a single "cure". It explains without needing to read 10,000 papers why we keep getting research talking about treatment X helps in some, but not all cases or symptom Y is associated in some, but not all, etc.
This is some personal opinion that I would bet the vast majority of Alzheimer's researchers would not actually agree with. The current consensus is that Alzheimer's is a particular disease, or a cluster of similar diseases.
I'm not saying your wrong, just that the level of confidence in your assertions is not warranted.
After spending years tracking through the genetics, conditions, lab work, research papers and seeing individuals years into the condition, this model is the best I have and explains everything I currently know. Why the cluster of conditions result in the same outcome, why some treatments help some folks, but not others.
But that is sort of the point of science, you take all the evidence you have and create a hypothesis and iterate as you get more evidence. If I find evidence that suggests something else then I will be happy to tweak or abandon this. My level of confidence comes from the existing evidence and lack of evidence otherwise.
You forming a personal opinion after years of interest in the subject is fine. You asserting that opinion as a fact is the problem.
It is a tale as old as time. See the story behind the term. ultracrepidarian: https://en.wiktionary.org/wiki/ultracrepidarian#English
Versus https://en.wikipedia.org/wiki/Argument_from_authority
See also: https://www.science.org/content/article/potential-fabricatio...
Amateur's asserting their opinions as facts isn't great, but epistemologically it's no worse (and systemically, like less harmful) than when the experts do it.
Experts, when given the chance, have a tendency to speak with nuance and describe the degree of confidence they have in different statements.
Compare this with an amateur writing with certainty about a subject that subject matter experts continue to debate after decades of work.
I know which one of the two I would rather bother listening to.
You just moved the goal post.
Saying that experts are less likely to do X doesn't say anything about the relative harm of their doing so. If some rando on the streets is shouting their opinion about what causes Alzheimer's and asserting it's God's Own Truth, it's going to cause less overall harm that a carefully worded (but equally wrong) statement from an expert. (And the fact that we tend to hold experts in higher regard is the reason we should be more concerned about them stating their opinions as facts than about amateurs doing the same.)
I want to know so that I can make plans. Including end of life plans, in all senses.
Exactly - there are things that I would change now to make sure I make thing easier for myself and - more importantly - easier for the people around me.
Those plans should be in place regardless of the results of a blood test
I think there are many people (myself included) whose plans would change dramatically upon discovery of Alzheimer's, dementia, or some other degenerative disease. I might consider moving to somewhere with more liberal assisted suicide laws for example.
No, they shouldn’t. Makes no sense to plan for living with a mental disability if you’re not close to needing it.
I am absolutely not going to plan on a care facility right now. That sounds absolutely bogus.
Notarizing any wishes against some medical procedures in case a sudden accident ruins your ability to dissent prevents doctors from being forced to keep your body alive as long as possible.
That doesn't apply to Alzheimer's disease directly though. If you don't want to live when your conscious life is limited to short flashes of awareness among a deeply terrifying melange of visions of the past and hallucinations, DNR laws don't in any way force or even allow doctors to euthanize you. You can persist in this state for many years without ever triggering a DNR check.
That is sadly true but at least you can prevent them from feeding you through a tube when you forgot how to swallow
My genetics are such I'm more likely to drop dead of a heart attack too young.
If I were likely to develop alzheimer's, I'd make more and more expensive accommodation for power of attorney and trusts to shield assets while I was competent to do so.
I was more referring to an advance directive / living will sort of thing
That is one very, very tiny aspect of EOL planning.
Yes, like walking out into the woods before it gets too bad.
Like what? You should already have a will, life insurance, etc. even without the disease. All you're doing by knowing earlier is causing psychological harms to yourself and the people you tell, adding more years of anxiety, grief, and sadness for no gain. Think about the bigger picture.
Downsizing your house? Picking your long term care location? Changing your asset balance? Recording more photos, audio, and video?
Knowing an early, painful fate allows you to approach it with dignity.
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That is more or less the plot of the movie "don't look up".
https://www.imdb.com/title/tt11286314/
These are 50yos, not elderly retirees. What if knowing caused your employer to deny you a promotion? Im in the military. This sort of diagnosis on one's file could have real impact on future prospects. People already fear ADHD tests for the same reason. I know a guy who is leaving the military after 20+ years flying transports. He is applying to airlines. If you were an airline, would you higher an experienced pilot with a positive alzheimer's diagnois in thier medical data?
An argument for a robust social safety net for when a diagnosis threatens your career in a safety-critical field.
While not a cure, there are many known modifiable risk factors for Alzheimer’s, so to some extent we know enough to deflect / mitigate dementia: https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
>Refusing to improve early, probabilistic diagnosis because today’s treatments are modest confuses sequence with outcome.
While you're right from the perspective of humanity taking the steps of gathering data then tackling the disease, most developed countries have single payer healthcare systems that require some level of cost-benefit analysis to approve covering new diagnostic systems.
Alzheimer's disease progression doesn't seem to have any notable preventative indications other than 'eat well, exercise and stay mentally active', all of which are standard recommendations.
Recall that this isn't an issue deciding between funding and non-funding. It's an issue deciding between funding Alzheimer's diagnostics, new GMP agonists, new screening options for highly preventable cancers, etc. Building out a dataset is nice but unless that's surplus money redirected from other programs it's going to come at a real flesh and blood cost.
Alzheimer isn't new. You should compare it with a situation like:
Imagine you're born and you eventually learn that there's an asteroid on a collision course with earth, from way before you were born. It's going to take many years to get here and you may die before it hits and so far no scientists have been able to come up with a way to deflect it. Do you care?
Adding newness to the situation makes it wildly different.
Okay but even that analogy is limited. Incurable progressive diseases almost invariably have lifestyle factors, supplements, or medications that can at least slow the rate of progression for many people. Those are also often more effective when started during early stage detection. There is literally nothing the average person can do about the asteroid.
Absolutely, the belief in scientific circles is that the way forward to develop cures (or at least treatment that slows down the progression) is to treat it early. When you get to the point where you start showing clear symptoms, your brain is already mush. If you have a potential treatment that attacks the root cause, you would have to catch the very early, pre-clinical, stages of the disease, but without good diagnostics there is no way to do that (short of giving the disease to a wide swath of the population, like a vaccine... but that gets expensive very quickly, and side effects become a bigger worry.
I get the logic, but I think the emotional side is a lot harder than the asteroid analogy makes it sound
> We would immediately build better telescopes to track it precisely, refine its trajectory models, and begin developing propulsion systems capable of interception
That's not what would happen. We wouldn't mobilize. We'd fragment. Within days, the prediction would be declared partisan. One bloc would call it settled science; another would call it statistical hysteria. Billionaires would quietly commission private shelters while publicly funding studies questioning whether the asteroid even qualified as "large." News panels would debate whether the projected impact zone was being unfairly politicized. Conspiracy channels would insist the asteroid was fabricated to justify global governance. Others would insist the real asteroid was being hidden. Amateur analysts would flood the internet with homemade trajectory charts proving the professionals wrong. Death threats would arrive in astronomers' inboxes faster than research grants.
The film "Don't Look Up" is very similar to what you describe.
Maybe if you can keep the results a secret from health insurance companies you’d have a point. However, not everyone has coverage under a large organization’s umbrella, and these people might be denied coverage.
“We have no cure. I don’t want to know.” isn’t the same as “We have no cure. We as a society don’t want to know.”
People can be fine with being tested so that epidemiologists can work on growing our knowledge and, at the same time, not wanting to know their own diagnosis.
I agree. I feel that many medical doctors do not share this mindset.
>”We have no cure. I don’t want to know.”
Is this a response to another comment or did I miss the quote in the article? Otherwise it’s just a straw man.
When can we get it?
I do want to know.
If it is positive, that is still helping you accurately deal with whatever is happening to you.
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Your gut bacteria is the prevention and the cure.
That's a hypothesis. If we knew that for certain, it would be really big news; and we could investigate to learn why, and then we could isolate the causative factors and perhaps find other ways of deploying them… If you know something the rest of us don't, prove it: show us the evidence, show us the specific hypotheses, describe a repeatable experiment, show us the results if such an experiment has been performed.
If you don't know something the rest of us don't, don't be so arrogant about your pet theories. Such arrogance costs lives.
You do realize they already are investigating, right? Even looking into MS and parkinson. ALZHEIMER’S DISEASE (AD) and AD DEMENTIA Umbrella review (systematic reviews of SRs): https://www.nature.com/articles/s44400-025-00048-6
Systematic review + meta-analysis (basal microbiota; AD): https://alz-journals.onlinelibrary.wiley.com/doi/abs/10.1002... https://pmc.ncbi.nlm.nih.gov/articles/PMC11672027/
Replicated case-control + functional metagenomics (AD dementia): https://alz-journals.onlinelibrary.wiley.com/doi/full/10.100...
Large-cohort metagenomics (stage-specific / early pathology signals): https://pubmed.ncbi.nlm.nih.gov/40164697
Mendelian randomization (AD): https://pubmed.ncbi.nlm.nih.gov/38788075/ https://www.sciencedirect.com/science/article/pii/S227458072... https://pubmed.ncbi.nlm.nih.gov/40665707/ https://journals.sagepub.com/doi/10.1177/25424823261422629 https://www.medrxiv.org/content/10.1101/2025.08.20.25333769v...
Narrative / mechanisms (useful synthesis, not primary causal proof): https://www.sciencedirect.com/science/article/abs/pii/S15681...
MILD COGNITIVE IMPAIRMENT (MCI) / DEMENTIA (cognition-focused evidence) Systematic review (MCI or Alzheimer’s dementia; PRISMA, PROSPERO): https://www.mdpi.com/2035-8377/17/10/155 https://pubmed.ncbi.nlm.nih.gov/41149776/
Scoping review (MCI and AD gut microbiomes + interventions, through Feb 2023): https://pmc.ncbi.nlm.nih.gov/articles/PMC12825029/
Systematic review of microbiota-targeted interventions for cognition/dementia risk: https://www.sciencedirect.com/science/article/pii/S027153172...
RCT-focused systematic review/meta-analysis of probiotics for cognitive impairment risk/AD/MCI: https://pmc.ncbi.nlm.nih.gov/articles/PMC12645680/
FMT in dementia/MCI context (review of effects across neuro cohorts): https://www.sciencedirect.com/science/article/pii/S266635462...
MULTIPLE SCLEROSIS (MS) Microbiome signatures via global data integration / ML: https://pmc.ncbi.nlm.nih.gov/articles/PMC12383397/
Systematic review/meta-analysis of probiotics in MS (preclinical + clinical): https://journals.plos.org/plosone/article?id=10.1371/journal...
Systematic review + meta-analysis (antimicrobial exposure and MS risk; microbiome-disruption relevant): https://www.sciencedirect.com/science/article/abs/pii/S22110...
Mendelian randomization (gut microbiota causally linked to MS): https://pubmed.ncbi.nlm.nih.gov/39065244/ https://www.mdpi.com/2076-2607/12/7/1476
Broad MS gut dysbiosis and therapeutic modulation review: https://pmc.ncbi.nlm.nih.gov/articles/PMC12668904/
MS gut-brain-barrier and intestinal barrier review: https://www.frontiersin.org/journals/immunology/articles/10....
Example MS cohort biomarker/signature work: https://www.nature.com/articles/s41598-024-64369-x https://www.nature.com/articles/s41598-025-19998-1
PARKINSON’S DISEASE (PD) Multi-cohort metagenomic meta-analysis (Nat Commun, 2025): https://www.nature.com/articles/s41467-025-56829-3 https://pubmed.ncbi.nlm.nih.gov/40335465/
Large metagenomics cohort (Nat Commun, 2022): https://www.nature.com/articles/s41467-022-34667-x
Integrated multi-cohort gut metagenome (Movement Disorders, 2023): https://pubmed.ncbi.nlm.nih.gov/36691982/ https://movementdisorders.onlinelibrary.wiley.com/doi/10.100...
Metagenomic analysis (Movement Disorders, 2024): https://pubmed.ncbi.nlm.nih.gov/39192744/
PD causal-inference and MR discussion (review-type synthesis): https://pmc.ncbi.nlm.nih.gov/articles/PMC12512240/
MR study example (PD gut microbiota): https://journals.lww.com/md-journal/fulltext/2025/10310/caus...
> You do realize they already are investigating, right?
Yes. I also realise they have not reached the conclusion of this investigation. (Imagine this attitude towards a police investigation: "They're investigating Roger Rabbit, therefore he must have dunnit!")
A detail, but an important one: the blood test brought the initial diagnosis closer to the final one. The result reflects the agreement between both diagnoses. The usefulness of the blood test depends on the quality of the final diagnosis, which can still be wrong.
PSA to those with family affected by dementia/Alzheimer's at a relatively early age (say <70yo): Get them tested for STDs, specifically Syphilis.
Left untreated for a very long time (decade+), it spreads to the brain and causes dementia among other things. Older generations with stigmas, taboos, or from lower educational backgrounds seem (to me) less likely to get tested, so it seems plausible.
Source: Have recently discovered this myself with a family member from their neurologist.
Flip side, if you have an older relative who, all of a sudden, seems to have a lot of symptoms that suggest dementia, have them get tested for a UTI.
> Source: Have recently discovered this myself with a family member from their neurologist.
The reason this was detected is that such testing is a standard practice with new dementia patients—among many other tests that identify etiologies of dementia.
No need for a 'PSA'.
Definitely not the case, not in all regions, not even within the same country.
We only found out for my family member after the 3rd neurologist's opinion after ~2 years of this.
Not everyone does their professional due diligence - cue endless anecdata about the healthcare industry. It's good to just be aware.
> Definitely not the case, not in all regions, not even within the same country
Perhaps—but it's also possible that whoever was in the room with the patient declined STI testing (which I have seen, and which sometimes reflects lack of knowledge around extramarital affairs).
I'm just trying to make it clear that there are dozens of reversible/non-degenerative causes of dementia and there is no way that a fully-trained neurologist doesn't have these memorized.
It's like not knowing what a type system is as a programmer with a reputable degree—impossible.
edit: in fairness, many doctors have unease around discussing sex/infidelity—but the PSA maybe should be to encourage your doctor to put aside concerns around niceties in your parent's care.
Yeah lots of infectious things are being found to be able to cause dementia https://www.theguardian.com/lifeandstyle/2024/dec/01/the-bra...
much of the medical profession seems a bit behind the curve on recent findings.
Also, the Herpes family (hint: most of us have HSV-1), vide "Alzheimer's risk 10 times lower with herpes medication" https://news.ycombinator.com/item?id=17540094 and much more, https://hn.algolia.com/?dateRange=all&page=0&prefix=true&que....
And "The effect of shingles vaccination at different stages of dementia" https://news.ycombinator.com/item?id=46164646 (yes, also the Herpes family).
Lenin famously died from it, you could see that obscure blank stare of a crazy person on his later photos
He was shot in 1918 leaving bullets in his body and left him weakened, then in 1922 he suffered at least three debilitating strokes. He lost his ability so speak and had to learn to speak again. He even proposed assisted suicide because he was suffering so much. He then had a final fatal stroke in 1924. I don't think "he looks crazy so he must have had some STD" is medically accurate or remotely appropriate on what's supposed to be an academic forum. He most likely had brain damage towards the end thus his illness of course was reflected on his body looked. Lenin's eyes reflected his post-stroke damage.
He was quite sane in his life and his work expanding on Marx is of course extremely important.
It's still debated whether Lenin died of syphilis. It's less wrong to say he died of strokes.
Paper is at Springer Nature Link: https://link.springer.com/article/10.1007/s00415-026-13676-6
Alarm bells go up. 94.5% in itself is suspicious. It insinuates precision. I highly doubt you can go anywhere near 0.5% correctness.
that doesn't bother me but what is actually suspicious is persistently only mentioning "accuracy" but not sensitivity / specificity / precision etc.
Basically, almost everybody doesn't have Alzheimers. Sampling from the general population you can get better than 94.5% accuracy just by returning negative on every test. You have to know sensitivity and specificity separately to make any informed judgement ... which they try extremely hard not to tell you.
> 94.5% in itself is suspicious
No it's not, that's a reported mean, presumably with the right number of significant digits.
If you want to criticize the variance/stddev, do so, but you picked the wrong metric if that's what you wanted to complain about.
How about this:
What accuracy does this have?> Compared with the final diagnosis, the pre-biomarker diagnosis was maintained in 71/200 cases (75.5%) (Kappa = 0.576), while the post-biomarker diagnosis was maintained in 189/200 cases (94.5%) (Kappa = 0.906).
Even without this method, the doctors have been able to give diagnosis with 75.5% accuracy (according to the paper's claim).
It says "accuracy". For the overall assessment.
I.e. it needs the original 75% accuracy or so and boosts it another 20%.
The problem is that the assessment itself is slow, expensive and requires skill.
What we really want from a test is high specificity (a positive test means you have accuracy) and high sensitivity (if you get a negative test you don't have it).
This is how we can offer screening.
Maybe I've misunderstood something, but how can they know the accuracy of the test? It is the best test out there, so if it misses a diagnosis, how do they reliably catch the false negative?
It’s one of the best blood tests. There are also PET scans, lumbar punctures (spinal taps), and postmortem analyses of brain tissue.
Person has Alzheimer‘s (diagnosed by neurological assessment). Test this person with a blood test.
If the patient forgets to follow-up. Badum tss. Thanks for the layup.
Besides being a bad joke, this is in terrible taste on a thread read by people with Alzheimer's patients in their lives, and it violates HN's rules that discussion should be valuable and inspire curiosity.
This isn't Reddit.
Could earlier diagnoses contribute to finding causes and treatments?
Or it's cached and ready to be useful when a treatment does come around. Either way it's welcome.
Maybe that’s actually one of the biggest reasons researchers care so much about earlier diagnosis
I'd be curious to see how it performs outside of a specialist neurology setting and in larger, more diverse populations
https://pmc.ncbi.nlm.nih.gov/articles/PMC8755961/
"A narrative review on the effects of a ketogenic diet on patients with Alzheimer's disease"
https://www.sciencedirect.com/science/article/pii/S127977072...
"Effects of ketogenic diet on cognitive function of patients with Alzheimer's disease: a systematic review and meta-analysis"
And anecdotes from the field:
https://www.youtube.com/watch?v=s86CFw0qhVc
Revolutionizing Assisted Living: Hal Cranmer's Ketogenic & Carnivore Approach to Senior Wellness / Metabolic Mind
so 94,5% sensitivity, or specificity? this thing with medical testing and false positives is tricky
Since the recent discoveries about Shingles Vaccine delaying dementia https://hsph.harvard.edu/news/link-between-shingles-vaccine-...
One of interesting checks in this study might be to check when (if) any of the participants had taken this vax and what the impact might be on an Alzimer's diagnosis.
Purely anecdotal, but I witnessed a person starting to experience a severe cognitive decline right after the two doses of the Shingles Vaccine. It can surely be a coincidence, but I was very surprised when I read about this study.
This anecdote is just that - a one off. We can use experiments, and papers to learn more, and should.
This needs to include life-changing false positive rates. Imagine being given a diagnosis like this - people around you who know and any corporations who can sniff it out by snooping on your communications can lead to much rejection early in life. What happens when the diagnosis is as positive when it shouldn’t have been?
This isn't a predictive test that someone could take in early life.
It's used to refine clinical diagnosis after patients present with cognitive severe decline.
By the time someone gets this test, they have severe problems. The purpose of this test is to assist with the right diagnosis.
As per the article, the test is used in conjunction with clinical diagnosis, not instead of.
https://doi.org/10.1038/s41591-025-03622-w this is the paper they're basing the research on. So in primary care, the accuracy rates are in the 80s. So that's something like a 17% false positive rate. That's still like 5 to 1 odds of getting a correct result though. It's much better than nothing.
Sorry, but the test hasn't been shown to be 94.5% accurate. The study was structured as: 1. neurologist makes clinical diagnosis using usual tools and records most likely diagnosis and their confidence in it 2. new p-tau test is done. 3. neurologists reassess their confidence, and change their mind in many cases. There is no "gold standard" here (tough to have in AD) and not even a period of clinical follow-up to assess for any interval change. The study shows that patients got reclassified, but never showed that such reclassification was more accurate than the initial one, and by how much. There is an implication that because in a different, retrospective study the test did show some accuracy, that it would be helpful in this new situation. But that's about it, and different than directly showing this to be the case.
This is Theranos levels of marketing.
Great but the big problem is how to actively treat it. Sleep is a huge factor and that’s a problem for us insomniacs :(
40 hz ultrasounds are part of the remedy.
Sir this hackernews please provide sources
https://news.mit.edu/2025/study-suggests-40hz-sensory-stimul...
n=5, success rate 60%, not blinded; but it does appear that they already had reason to test the treatment, so it's not a green jellybeans situation.
94.5% is actually terrible.
If you have a prevalence of 10 in 1000, how do the numbers shake out?
Well, you test all 1,000. If we assume a 95% accuracy for false-positive and false negatives?
Of the 990 that you test that don't have the disease, the test will false state 50 do have the disease. Yikes!
And of the 10 that do have the disease? You'll miss 1 of them.
This improves the diagnostic accuracy from around 75% to 95%.
It's not terrible. This is a relatively good number. Diagnostics is just terribly difficult.
I got bad news about the specificity for most things this serious. Think the only one we absolutely nail is infectious disease detection.
Spoilers: It's anywhere between 1-15 and 5-30% for false positives and 1-15/5-40 for false negatives. That's imaging, biomarkers, cancer screenings, etc
Like, where do you think the concept of "second opinions" came from? Whimsy? Lets go ask a second doctor if I actually have cancer, it'll be fun!
> 94.5% is actually terrible.
This statement is quite broad and misses several important factors.
First of all, a test's sensitivity and specificity. The math in your example assumes a balanced test, but on what basis? The math comes out quite different for high-sensitivity or high-specificity tests. (Unfortunately, I could not find the numbers for the test in the linked article.)
Secondly, whom are we testing? The prevalence rate in your example (1%) is unrealistically low even for the general population. But would we screen the general population? No, we'd screen high-risk groups: the elderly, those with certain APOE genotypes etc. Predictive values of a test depend hugely on the prevalence rate.
Lastly, it depends on how the results are used. If it's a high-sensitivity test used to decide whom to send to the next tier in a multi-tier diagnostic system, it could actually be quite effective at that (very rarely missing the disease while greatly reducing the need for more expensive or more invasive testing).