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Do you have a brain? Well then, you are at risk for Alzheimer's...

10/2/2018

 
I still dramatically arch an eyebrow when cures or proclamations in general are made about Alzheimer's disease. But when Peter Attia, MD weighs in--he has my attention. I am confident that you are able to Google with the best of them so hope you will do your due diligence and appreciate the insights and appropriate level of granularity he is able to deliver. I mention him here and here if you are short on time.

The Peter Attia Drive podcast with Richard Isaacson, MD is long and in depth. Peter knows you are easily distracted and his team produces stellar show notes for quick reference. My schedule of 2 to 3 hour trail runs were made for the hypnotic focus of the format. Think of what you thought you knew--now consider it a palimpsest--seek the critical thoughts and evidence based logical thinking and change your mind...okay this sounds a little fandom-y but when you are surrounded by blather and self-aggrandizing  listicles of how to be this or that--the truth can be like manna.
I like to think of charts and graphics like little arguments. They are to be read, not briefly scanned or summarized without thought or reason. The poster below is mentioned in the podcast and I thought to expedite this post I would topically introduce it to you for your edification and review.

What is a prospective cohort study? The prospective part of the study describes subjects enrolled into a cohort or group that have not yet developed the outcome of interest. None of the subjects in the study below actually have been "diagnosed" with Alzheimer's disease--read the study design for clarity. Longitudinal (over a period of years) studies are needed to observe and identify potential risk factors or associations with disease outcomes.

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There will never be a monotherapeutic cure for Alzheimer's disease. Prove me wrong but I can't imagine it and to date over 99% of research in the field have been consistent with this hypothesis. The investigators of the study are examining multiple AD, dementia, and vascular risk scales and their response to multi-modal interventions. Secondary outcomes include measures of blood biomarkers and cognition.

The two genotypes are ApoE (epsilon 2, epsilon 3, and epsilon 4) and MTHRF C677 1298c:
  • MTHFR A1298C = heterozygous mutation (one mutation)
  • MTHFR C1298C = homozygous mutation (two mutations)
  • MTHFR C677T + MTHFR A1298C = a compound heterozygous mutation
The point is to notice the stratification of variations in response for blood biomarkers and cognitive tests (figure listed in Results). The green blocks signify "significant" improvement over 6 months. I need a confidence interval here to be convinced p<.05 indicates anything of note or if there are meaningful clinical outcomes over time but at the very least--there is much to consider for additional investigation.
​“Anyone with a brain is at risk for Alzheimer’s.” —Richard Isaacson

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    Bonny

    A data analyst focuses the lens on the evolution of Alzheimer's Disease as a diagnosis into a billion dollar healthcare juggernaut

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