Spinal-Fluid Test Confirmed To Predict Alzheimer's

omnibit writes "The New York Times reports that researchers have found a spinal-fluid test can be 100 percent accurate in identifying patients with significant memory loss who are on their way to developing Alzheimer's disease. The new study included more than 300 patients in their seventies, 114 with normal memories, 200 with memory problems, and 102 with Alzheimer's disease. Their spinal fluid was analyzed for amyloid beta, which forms plaques in the brain, and for tau, another protein that accumulates in dead and dying nerve cells in the brain. Nearly every person with Alzheimer's had the characteristic spinal fluid protein levels."

Comments

Thank goodness:

[Fluffeh]

I hope that an easy text will be developed from this in the next few years. I couldn't imagine walking into a haze of Alzheimer's without knowing about it. This is one of those tests that I will ABSOLUTELY not be missing once I book it in.

Re:Thank goodness:

[solevita]

And on the plus side, if you do have Alzheimer's you will at least be able to forget about the late life spinal tap.

Re:Thank goodness:

[Anonymous Coward]

For easy texts, refer to creations from CS Lewis and Roald Dahl

Re:Thank goodness:

[Rei]

Yeah... too bad it's a spinal fluid test. Those are nasty. My spouse had one and the hole in the dura refused to close, which is apparently a fairly common side effect. Net result: unbearable, nonstop, over-10-on-a-1-to-10-scale headaches that can't be controlled with headache medicine. Caffeine on an IV drip works, but only temporarily. The headaches lasted for weeks until the doctors finally managed to close the hole with a blood clot. The clot doesn't actually fix the problem, but the dura managed to repair itself while the clot held. I've heard of people, however, who *never* healed from it. What a miserable experience.

Re:Thank goodness:

[ColdWetDog]

That happens, but it is rare. But because of the potential numbers of people who would want the test, the difficulty of doing a lumbar puncture (spinal tap) on persons who have arthritis in the back (very common among us ancient folk), are of the supersized persuasion, or have other reasons to dissuade themselves, I don't think this is going to be the ultimate test.

Instead it will serve as a proxy to allow simpler tests to be developed. TFA also notes that PET scans are fairly accurate. These are available at many larger medical centers but are also pretty pricey and technically complex.

This is also not the first time that lumbar punctures for beta amyloid have been used to diagnose Alzheimer's. And finally, the abstract of the original article for your viewing pleasure.

Re:Thank goodness:

[c0lo]

I hope that an easy text will be developed from this in the next few years. I couldn't imagine walking into a haze of Alzheimer's without knowing about it. This is one of those tests that I will ABSOLUTELY not be missing once I book it in.

:) Suggestion: make sure you make a note - actually, many of them - and post them all over in your home: this is to avoid the risk of forgetting about the test by the time it gets approved :)

Re:Thank goodness:

[Have Brain Will Rent]

Yup my Dad had that done and he said it was the most painful thing he'd ever had happen... and this was a guy who grew up on a farm (a great source of pain), served years in combat during WWII and so on and so, on without ever raising a complaint.

The next time he had to go in was because of a disc problem and they essentially injected his spine with meat tenderizer to dissolve the ruptured disk away. He said compared to the spinal tap that didn't hurt at all (except for the nurse yanking his boxers off without first checking for protrusions - yikes!).

Re:Thank goodness:

[c0lo]

Apologies, I thought the smiley-s would clearly indicate the post as meant to be on the funny side (and by no means offensive, flame-ing, much less trolling).

On the serious side, if the original poster thinks her/himself at risk, I wouldn't recommend the original poster to skip any Alzheimer's test just because of this piece of news: given the time required for FDA's approval it may be too late (granted, since it is a test only, the time to approval may be shorter than for a drug, but anyway...)

Re:Thank goodness:

[Kepesk]

What was this test for? I can't remember... And how did I get up in this tree?

Re:Thank goodness:

[v1]

And on the plus side,

Ok, cue the "One of the great things about having Alzheimer's is..." jokes

- you can wrap your own presents
- you get to meet new people every day
- you can hide your own easter eggs (my fav)

need more!

Re:Thank goodness:

[0100010001010011]

Only 100% accurate? Given the necessity for a spinal tap it should go to 110%.

Re:Thank goodness:

[cgenman]

In her early onset of Alzheimer's, I used to say shocking things about my life to my Grandmother. She'd be surprised, righteously indignant, and secretly curious. She'd ask all sorts of questions. Fifteen minutes later, we'd do it all again.

When I left from these visits, she'd be absolutely glowing. She'd be awake, excited, and extremely happy. And she had no idea what happened. Next time in, I could make the shocking revelations again with the same effect.

Re:Thank goodness:

[hey]

If I had points I'd bump you to 6.

Re:Thank goodness:

[electrostatic]

Man visits his doctor.

Man: "What's the news, Doc."

Doc: "Not so good. Test results show cancer, and ... spinal fluid indicates ... Alzheimers."

Man: "... Well, at least I don't have cancer."

Re:Thank goodness:

[Rei]

The debilitating headache is not rare; it occurs in a third of all cases and normally lasts 24-48 hours. What's rare is when it lasts a year or more. Somewhere in-between is my spouse's case, which lasted a couple weeks and took medical remediation.

Re:Thank goodness:

[Anonymous Coward]

That's sounds like an awful side effect that I've been fortunate enough never to experience in any of the several lumbar punctures (herein refereed to as "LPs") I've endured.

A huge part of the pain with LPs is the fear of the unknown; not knowing exactly when the needle will hit because you can't actually see it happening. I know and understand the hesitance associated with LPs, but there are actually two ways to do it.

There's what I would call the jar-of-leeches way: performing the procedure at the hospital bed while the patient sits upright, with the needle placement guided by an educated guess. This was how I experienced my first LP; it was so excruciatingly painful, I'd have passed out if I had it had been completed just a few seconds later. I've experienced a lot of pain related to medical procedures for my chronic condition, including surgeries, biopsies and so-on, and I've the only thing that came close on the pain richter-scale was having six feet of cotton jammed up each of my nostrils (not an exaggeration). I would not consent to an LP being performed this way again.

Then, there's the proper and modern way of doing it: performing the procedure in a semi-dedicated lab with a fluoroscope while lying on a specialized bed tiled to about 25 degrees. This allows the specialist performing the procedure to literally see a live x-ray so that the needle can be placed very precisely; ie.: to miss nerves and minimize the risk of misplacement. When performed in this manner, it's still uncomfortable, but it's not even that bad in terms of pain level.

Re:Thank goodness:

[epp_b]

Actually, if the procedure is performed properly and you actually lie flat in a bed for two hours like you're supposed to, the risk of headache is very low.

Re:Thank goodness:

[jordan_robot]

...are of the supersized persuasion...

You mean, like a huge cock?

Sucks for those guys.

Re:Thank goodness:

[Profane MuthaFucka]

-Republicans will still look up to you for your intelligence

Re:Thank goodness:

[DrGamez]

Please take this comment in lieu of actual Karma points, because I have none.

Re:Thank goodness:

[tkjtkj]

Your comment "But because of the potential numbers of people who would want the test, the difficulty of doing a lumbar puncture (spinal tap) on persons who have arthritis in the back (very common among us ancient folk), are of the supersized persuasion, or have other reasons to dissuade themselves, I don't think this is going to be the ultimate test." is misleading. As a retired anesthesiologist with well over 20 years medical experience i can state that i have never experienced any patient whom i could not obtain a successful "spinal tap". Yes, a very small number were difficult, but in the hands of a professional your concern is misguided.

Re:Thank goodness:

[aqk]

I hope that an easy text will be developed from this in the next few years. I couldn't imagine walking into a haze of Alzheimer's without knowing about it. This is one of those tests that I will ABSOLUTELY not be missing once I book it in.

Ummm.. don't you remember?
You had one of those tests last week. You told me so.

Re:Thank goodness:

[Rei]

Link: "Spinal headaches occur in up to 30 percent of those who undergo a spinal tap (lumbar puncture) or spinal anesthesia."

And almost nobody gets up during those two hours because the doctors typically make you lie flat. The dura just doesn't deal well with being punctured. Some people heal quickly. But a large minority don't. And some never heal.

Re:Thank goodness:

[Khyber]

Some of us may need that tap in mid-life. Seeing how a majority of my family passed away, I know I'm certainly getting the test done.

Re:Thank goodness:

[CrashandDie]

I've never had meat tenderiser shot up my back, but I've had two lumbar punctures. The first one wasn't too bad, the second one was almighty awful.

The only thing I underwent that hurt more was after a fight (I was doing street photography and was attacked by a bunch of youth), I had a corneal abrasion on my left eye. My understanding of it is that there was a small hole, gap, or something, on the outer layer of my eye, against which my eyelid rests. I had this small gap dead centre in front of my iris (or whatever you look through is called).

You may not be aware of this, but your eyes move constantly, and having a little gap in what used to be the smooth surface of your eye means that with every tiny movement of your eye, there's friction. I didn't notice anything after the fight, however, the next morning, I woke up around 5AM and was effectively blind (I couldn't open the other eye, as that would cause my other eye to try and open too). For the next two days, I was blind, not because my eyes were unable to see, but because the pain was unbearable. At the hospital, I was given a topical anaesthetic, which removed any trace of pain. That nurse became my new best friend. Though, what it didn't remove was the massive photophobia I was suffering from.

Photophobia is a very disturbing phenomenon. We aren't used to having our eyes not adapt to the available light. No matter where I went, everything was overexposed. I couldn't read anything written on white paper (too bright), they had to switch off all the lights in the exam room for me to get the eyesight test done.

Luckily, just over a week after the incident any discomfort was gone, I still had problems focusing (which lasted for about a month), and dry eyes (fake eyedrops are a godsend), and photophobia remained for about 3 months, in a lesser extent than previously. And using sunglasses when reading your email doesn't make you look cool, it just makes you look stupid.

Being an avid photographer, I was shell-shocked that my eyesight was so fragile, and that even though the pain withdrew relatively quickly, being blind for a couple of days really made me very, very humble towards people who have live with that handicap on a daily basis.

Makes you think, of all the senses we have (hearing, vision, smell, touch, and some might even argue that memory is a sense as well), which one would you choose to lose if you had to? We take a lot of things for granted, our body, and our most basic senses that make up the experience of self. If you couldn't remember the experiences that made you 'you', would you still be 'you'? Would you still be yourself if you couldn't see, or hear?

Re:Thank goodness:

[RivenAleem]

5.5 Surely?

Re:Thank goodness:

[uglyduckling]

Actually, I don't think this test is all that useful. According to the article, the test was validated for people with significant memory loss. Alzheimer's can really be diagnosed clinically in that group, so the test won't add all that much, and if it is from spinal fluid then it involves a painful and invasive lumbar puncture (spinal tap). I would say that this test is of academic interest, a step in the right direction towards finding a test that can be used early on. There is more interesting research into bloods tests which are less invasive.

Re:Thank goodness:

[ColdWetDog]

... but in the hands of a professional your concern is misguided.

My point being that a technically difficult test, one that requires a significant amount of specialty training, isn't ideal for something that may end up being a screening test (where you are testing a large number of people, most of which won't have the problem). That also is an issue with PET scans since they're technically demanding and complex.

The utility of having a fairly specific test for Alzheimer's, on that doesn't require brain biopsy - the ultimate bad screening test, will hopefully allow researchers to come up with something more suitable for a generalized test.

It's really the same issue as a colonoscopy for colon cancer screening. It's sensitive and specific but a pain in the ass (so to speak).

Re:Thank goodness:

[pnaro]

Been there. I'd rather put a bullet to my head than live with a spinal headache for an extended period of time. I'd say it was a 14 on the scale of 1-10. Worse things I've ever experienced in my life ... even after 2 back surgeries!

Re:Thank goodness:

[rgviza]

-Republicans and Democrats will still look up to you for your intelligence.
**************
There, all better. Both kinds of sheeple drink too much koolaid and believe whatever politicians tell them.

Re:Thank goodness:

[Anonymous Coward]

i think i love you

Re:Thank goodness:

[weiserfireman]

My Dad was diagnosed with Alzheimer's last year. He refuses to take his meds. He doesn't think he has it. Everyone around him can see it. It is a horrible horrible disease

Re:Thank goodness:

[Idarubicin]

Yeah... too bad it's a spinal fluid test. Those are nasty.

I'm with you -- though I suppose it would only applied as a 'final confirmation' sort of test to rule out much rarer neurological conditions, after all the other, less-invasive tests had been exhausted.

Truth be told, the result described in the paper isn't particularly exciting; it just looks at a larger population of patients than has been used in the past, and teases out some correlations that were already expected. It may also explain some minor contradictions between previous studies that (could have) resulted from different timing of sample collection relative to time of disease onset. I'm not sure why this is making the news, except that there isn't a "We've cured cancer (again)!" story for the Times' science writers today.

I'm far more interested in seeing how some less-invasive diagnostics are going to turn out. There's some very interesting work going on which uses the eye and retina as a convenient window on the brain. There is work using several markers for Alzheimer's disease (either generic markers of cell death in retinal cells, or specific protein tests in the retina or aqueous humor) that employ simple eyedrops for delivery, and read out using straightforward fluorescence. Here's one; there are a number of others in the pipeline as well.

Re:Thank goodness:

[Anonymous Coward]

I'd go all the way to 11.

Re:Thank goodness:

[Wyatt Earp]

Two hours?

When I had spinal taps for chemo, it was a half hour if I didn't have MP-6 or Methotrexate and 90 minutes if I had.

Re:Thank goodness:

[Wyatt Earp]

I've had 38. They always sucked.

Re:Thank goodness:

[Profane MuthaFucka]

Evidence please? On my side, I cite the fact that Republicans could not tell that Reagan was senile, despite the obviousness of his condition.

Re:Thank goodness:

[HiThere]

Why?

If there's a treatment, then it might be useful to know early if you're going to get it. If there's no treatment, it only means that your health insurance is going to start looking for excuses to cancel your policy.

100% of the time?

[Some.Net(Guy)]

Did they only test one person because they kept forgetting they'd tested him?

Re:100% of the time?

[Anonymous Coward]

I'm more confused by this.

researchers have found a spinal-fluid test can be 100 percent accurate

Later followed by

Nearly every person with Alzheimer's had the characteristic spinal fluid protein levels

So it can 100% predict what not 100% of them have...?

Re:100% of the time?

[interkin3tic]

300 people. In the summary.

100% meant it was, as tested, 100% accurate with no false positives or negatives.

Re:100% of the time?

[Aladrin]

Actually, they're saying that if they detect amyloid beta, you are on your way to Alzheimer's. Guaranteed. If they don't detect it, all bets are off.

Oh wait, that's not even right:

"And about a third of people with normal memories had spinal fluid indicating Alzheimer’s. Researchers suspect that those people will develop memory problems."

So it's just a lie about the '100%'.

Re:100% of the time?

[interkin3tic]

Nearly every person with Alzheimer's had the characteristic spinal fluid protein levels

So it can 100% predict what not 100% of them have...?

There were two proteins being tested. Say out of the hundred alzheimer positives, two had tau levels that were below the average for alzheimer patients by a statistically significant amount BUT significantly higher than the average your non-alzheimer population , and their beta amyloid levels were normal for an alzheimer positive, then you could say it was 100% accurate, nearly every patient had the -characteristic- levels, and the NY times would probably summarize it like they did.

Alternatively, maybe beta amyloid and tau were not detectable above noise in people without alzheimers, and were present in every alzheimer patient, but there was some variety in the levels due to amount of plaques present (amount of tissue leaking these proteins). That could also account for the "nearl every person had the characteristic levels..."

Re:100% of the time?

[nospam007]

The ones with normal memory showed up for the test on time, so it's no longer double-blind.

Silly question

[MichaelSmith]

I know that amyloid beta in the Cerebrospinal fluid is a secondary symptom of plaques on neurons, but I wonder of filtering or replacing the CSF would help the situation at all?

Re:Silly question

[interkin3tic]

I'd guess it wouldn't be worth the expense since, as you noted this is secondary. It's not even a secondary -symptom-. It's not going to do anything besides cause massive headaches. Literal headaches, that is. It would be a bit like trying to fight a fire by clearing the smoke out of a burning building.

Re:Silly question

[MichaelSmith]

massive headaches

Yeah I know. My nephew has fungal meningitis, which is weird, nobody knows where it came from. He is otherwise very healthy. His condition was diagnosed when the infection pushed up the pressure of his CSF and caused exactly those symptoms.

Re:Silly question

[Anonymous Coward]

Not silly at all. Some of the current R&D drugs are focused on dispersing plaques to increase the brain free amyloid levels so that it can wash out --either blood or possibly into the csf pool. Also plaque formation is not on neurons but in the inter-cellular spaces.

Re:Spinal test fluid confirmed to ... umm what?

[binarylarry]

Don't worry, I remember perfectly.

Apparently Spinal Tap is reforming and they're kicking off the new world tour in Alzheimer, Germany.

It's going to be killer.

Ouch!

[Anonymous Coward]

And who put this tube in my spine?!?!?

Why was I hitting submit again?

100% Accurate, Nearly All of the Time!

[Alphanos]

So, just to clarify, this test "can be 100% accurate", while at the same time "Nearly every person with Alzheimer's had the characteristic spinal fluid protein levels."

That's a pretty neat trick.

Re:100% Accurate, Nearly All of the Time!

[GNUALMAFUERTE]

Yeah, not only that, but also it says that many people without Alzheimer's turned out positive too ... so they assumed those are going to develop Alzheimer's.

It produces false negatives, and it might be producing false-positives, but we won't know until 10 or 20 years later. But it still is 100% accurate. Nice math there. This trend of early publishing non peer reviewed material while making extraordinary claims, only to never hear from it again is starting to get really old.

Re:100% Accurate, Nearly All of the Time!

[jethr0211]

Probably meant they predict near zero rate of false positives.
Ahh, statistics; in the hands of amateurs, any conclusion is possible.

Re:100% Accurate, Nearly All of the Time!

[rickyb]

Exactly. Especially in medicine, no diagnostic test can ever be considered 100% accurate unless it could be tested on every single person who ever had the disease in question and who ever will have the disease. Try getting funding for that! Any article (or summary of an article) discussing the statistics of a diagnostic test should also include mention of the specificity and sensitivity of the test. Biostats 101, guys (and gals).

Re:100% Accurate, Nearly All of the Time!

[Anonymous Coward]

300 patients, one misdiagnosed
299/300 = .9966 = 99.66%
you want 3 sigfigs
100%

Re:100% Accurate, Nearly All of the Time!

[h4rr4r]

299/300 = .9966 = 99.66%
you want 3 sigfigs

99.7%

Re:100% Accurate, Nearly All of the Time!

[ezralanglois]

This is simple to clarify. The tests to detect these proteins are not 100% perfect but they get more sensitive every year. So just because they are not detectable in certain patients does not mean they are not there. So, this paper just came out recently, that means it was probably submitted for review 3 months (or more) and the actual experiments may have taken place at least a year ago. So in that time, the tests for these proteins have improved yet all the samples that were collected a year or more ago have been used up. Thats only part of the reason they claim "can be 100%"; the other part is that there is already strong evidence to indicate that these proteins are involved in Alzheimer's so they should be present even if they were not detected.

Re:100% Accurate, Nearly All of the Time!

[BitZtream]

Peer reviewed ... heh, a simple random 'read it myself before I hit submit' should fix most of this kind of crap it seems to me.

Re:100% Accurate, Nearly All of the Time!

[Anonymous Coward]

This trend of early publishing non peer reviewed material while making extraordinary claims, only to never hear from it again is starting to get really old.

Starting? It's as old as the newspaper if not older. Everyone in accedimia knows that publishing outside of peer review is admitting there are serious flaws someone didn't feel like fixing.

Still, since the article comes out tomorrow, I'm willing to assume they didn't claim 100% accuracy. That's the kind of silliness that gets added by a journalist. Every time one of our articles (geophysics) gets covered in the press you can hear people laughing the next office over as they read the story.

Re:100% Accurate, Nearly All of the Time!

[timeOday]

Read it again, because there is nothing in the article that contradicts the claim that "researchers have found a spinal-fluid test can be 100 percent accurate in identifying patients with significant memory loss who are on their way to developing Alzheimer's disease.":

"Nearly every person with Alzheimer's had the characteristic spinal fluid protein levels. Nearly three quarters of people with mild cognitive impairment, a memory impediment that can precede Alzheimer's, had Alzheimer's-like spinal fluid proteins. And every one of those patients with the proteins developed Alzheimer's within five years. And about a third of people with normal memories had spinal fluid indicating Alzheimer's. Researchers suspect that those people will develop memory problems. "

However, the test can only be 100% accurate if the spinal fluid proteins that presage Alzheimer's decrease after full onset.

The fact that not everybody who tested positive developed Alzheimer's during the study is no counter-indicator at all, especially if they kept testing new subjects throughout the trial (i.e. some were only tested recently).

Of course, the usual caveats apply - you can't predict with 100% accuracy who will develop Alzheimer's years from now because some will die first of other causes. And in biology (and medicine), even if your test is correct on the first 10 patients, and the first 100, and 1000, you just know some smart-alec is going to buck the trend eventually :) Biology is just too messy to follow any simple rules all the time. But that doesn't necessarily have a whole lot of relevance to clinical applications.

Re:100% Accurate, Nearly All of the Time!

[Anonymous Coward]

So, just to clarify, this test "can be 100% accurate", while at the same time "Nearly every person with Alzheimer's had the characteristic spinal fluid protein levels."

That's a pretty neat trick.

Everyone with the indicated levels has Alzheimers. But not everyone diagnosed with Alzheimers has the indicated levels. Why is that a neat trick?

Re:100% Accurate, Nearly All of the Time!

[GNUALMAFUERTE]

NEARLY. NEARLY. They said NEARLY every person with Alzheimer's tested positive. If NEARLY every person develops the characteristics you are testing for, NEARLY ALL ALL. NEARLY 100%. That means they are getting FALSE NEGATIVES.

On the other hand, out of the people tested, many were POSITIVE, but we don't yet know if they are going to have Alzheimer's or not. So, we MIGHT HAVE FALSE POSITIVES.

That is exactly what my post said.

Don't get me wrong, a technique to easily prove for a hard to detect and identify disease, that has a low rate of false positives/negatives is still AWESOME. But it's not 100% effective, which is what the article claimed.

Re:100% Accurate, Nearly All of the Time!

[Anonymous Coward]

ADNI (the study on which the paper is based) has been tracking these folks for 5+ years. Enough cog normal folks have developed MCI and MCI's into full blown AD that the hazards analysis can be done with decent power. Don't pound on the stat's methods unless you read the paper ; NYT and other papers are known for doing hack jobs on "translating'" for the masses. CSF abeta is a decent bio-marker; there are pubs out there which show basic equivalency of the PET (PIB) tracers and CSF levels -- unless you need the spatial information from PET (which you probably don't if all you want is a go/no-go) there is no reason for the cost nor for the additional radiation exposure. PIB PET spatial specificity has not proven terribly useful to date.

The paper is peer reviewed.

Re:100% Accurate, Nearly All of the Time!

[dissy]

Yes, because news reporters don't know how to be accurate or consistent, lets just ignore and discredit the real scientists work :/

Re:100% Accurate, Nearly All of the Time!

[timeOday]

NEARLY. NEARLY. They said NEARLY every person with Alzheimer's tested positive. If NEARLY every person develops the characteristics you are testing for, NEARLY ALL ALL. NEARLY 100%. That means they are getting FALSE NEGATIVES.

That's not the point - the claim was that "researchers have found a spinal-fluid test can be 100 percent accurate in identifying patients with significant memory loss who are on their way to developing Alzheimer's disease." You are inferring that people who already have Alzheimer's should also test positive - but nobody said it was 100% effective for that. Perhaps the spinal fluid protein levels characterize people who are on their way to developing Alzheimer's, but not always those in whom the disease is advanced. I don't know if that's true, I'm just saying the article is not internally inconsistent.

Re:100% Accurate, Nearly All of the Time!

[sjames]

I wonder if the statistician tested positive?

Re:100% Accurate, Nearly All of the Time!

[Anonymous Coward]

Heh...to be pedantic, 300 has one significant digit. You need to specify that it is an exact number in some other form, such as 299/300. or by using scientific notation, 299/3.00x10^2.

Re:100% Accurate, Nearly All of the Time!

[priegog]

That's why when doing actual hard medicine (and taking important decisions regarding implementing certain test and whatnot) these claims do not bode. "100% accuracy" (or any percentage, really) means squat to a statistics-trained professional. There are precise measurements of the effectiveness and potency of a particular test, these mainly been sensibility and specificity. So a particular test may be very sensible yet not very specific (like the mammography, for detecting breast cancer), which means it can have many false positives (but not many false negatives), or the contrary, very specific but not very sensible...
There are related concepts like positive predictive value and such, but the important thing is, these things need to be measured before this test can make it's way into everyday clinical practice. If they weren't rated, medicine would be a very obscure art.

Re:100% Accurate, Nearly All of the Time!

[priegog]

Don't get me wrong, a technique to easily prove for a hard to detect and identify disease, that has a low rate of false positives/negatives is still AWESOME.

Too bad in reality what you're describing is VERY VERY rare (and much more so if you also wish it to be cheap). That's why statisticians have created measurements that help when taking clinical decisions. For instance, for a screening test (which seems like this is what it's planed to be) it's perfectly acceptable to have a high sensibility even if it has a low specificity. This way you'll "catch" almost all of the sick people for further study (with more specific, and most likely more expensive/time consuming/invasive/etc tests) even if in the process you "catch" a few healthy people too (which will later be declared so).

Re:100% Accurate, Nearly All of the Time!

[ebuck]

You have to be very careful because you don't know who wrote the NEARLY. It could have been a researcher or a journalist. Hold your judgement until you get your grubby hands on the actual research paper.

Re:100% Accurate, Nearly All of the Time!

[elrous0]

Too many "researchers" are way more interested in getting more grant money through PR and exaggeration than they are in real science.

Re:100% Accurate, Nearly All of the Time!

[Tarsir]

I wondered about the 100% accuracy. From TFA:

[Others doctors] note that [the test] is not reliable enough — results can vary by lab

It sounds like some lab somewhere had 100% accuracy, so they reported that number. Obviously they should have reported on the average accuracy across all trials, but I guess that'd be too much to ask.

Re:100% Accurate, Nearly All of the Time!

[qe2e!]

I know there's more than one measure of accuracy in medical studies. I forget the jargon, but there's always a measure of false-negativeness and a measure of false-positiveness. While they do have to admit a false negative, "some afflicted lacked the indicator", they may be able to say, "100% of healthy patients lacked the indicator". Ergo if you ever found it, you just made an inarguable diagnosis. So maybe a reporter didn't grok the stat. The false negatives are curious, though - some small percentage of the population has diseased brain tissue but clean fluids, as if their braincar had a great new oil filter.

Re:100% Accurate, Nearly All of the Time!

[Anonymous Coward]

Actually it says that it is "100% accurate in identifying patients with significant memory loss who are on their way to developing Alzheimer’s disease". Later in the article they back this statement up by saying "Nearly three quarters of people with mild cognitive impairment, a memory impediment that can precede Alzheimer’s, had Alzheimer’s-like spinal fluid proteins. And every one of those patients with the proteins developed Alzheimer’s within five years."

No where in the article does it say that it is a 100% accurate test across the board.

Sex Panther

[mosb1000]

60% of the time, it works every time.

Re:Sex Panther

[mtinsley]

I'm gonna be honest with you, that smells like pure gasoline

BAPtists and Tauists?

[Garrett Fox]

I'd heard years ago that there was dispute between researchers who thought the disease was caused by "beta amyloid plaques" versus by this "tau" protein. Does the test for both show that there's still no consensus on the cause, or has one been established as the cause and the other an effect?

Re:BAPtists and Tauists?

[Mishotaki]

Tau? i'd bet it's the Orks, not the Tau that's the problem!

Re:BAPtists and Tauists?

[interkin3tic]

Does the test for both show that there's still no consensus on the cause, or has one been established as the cause and the other an effect?

I think the fact that both are used merely shows that there's consensus that both are strong markers of the disease. Actually proving cause and effect is going to require better animal models, better culture systems to replicate the disease in a dish, or people willing to sacrifice themselves. I heard a seminar about 3 years ago by a "tauist," who was arguing that if you artificially expressed tau in mouse brains, their neurons started acting like early stages of alzheimers, but the mice never developed plaques. He suggested plaques might be a symptom that only comes up in human brains, or after several years longer than mice live, or some more complicated reasons, but he really didn't know. I haven't heard any research from a BAPtist, so I don't know the other side of the story. I'm guessing there haven't been any definitive answers since then.

The answer could be entirely academic anyway, this one causes that other one but both are necessary for the actual disease, so a treatment for the dependent step might be all you need, or the answer could be that both are required together, or that either one is sufficient to cause the other one.

Re:BAPtists and Tauists?

[Anonymous Coward]

Animal models in AD are on the receiving end of a lot of skepticism -- the plaques in "Swedish" mice aren't the same as in human AD -- at least that's what I think I remember.

Interestingly enough the APOE markers for AD correlate with differences in functional connectivity *in YOUNG people* (Filipini et al PNAS sometime in 2008 or 2009). So maybe the whole amyloid/tau discussion doesn't mean squat and by the time these percolate to measurable levels the brain has already started to fry circuits.
 

Re:BAPtists and Tauists?

[Garrett Fox]

Hmm, that's true. If (say) Tau is the root cause but it works by causing the BAP plaques, then we only really need to disrupt either of them and it doesn't matter which. It looks like clinical trials are planned for a "vaccine" that attacks the BAP, so hopefully we'll get some useful results from that even if we don't fully understand why it works.

Not just a test benefit

[Eccles]

Not only does this give an actual test for Alzheimers, it also means that there's a definitive symptom for it. Wipe out the cause of that symptom and maybe you can stop or reverse the progression of this horrible affliction.

My father is already at the moderate dementia stage of this illness, and it's devastating. Not so much for him as it is for my mother.

Re:Not just a test benefit

[blind biker]

Let's first see exactly what the test is. If they test for amyloid beta peptides, the test may give false positives (a lot of people with amyloid beta plaques have not had any cognitive decline (note that prior to this test, the plaques could be only detected posthumously)). And if this "new" test is like the one I have read about previously, then it does only look for Abeta peptides. And nowadays most of the Alzheimer's durg research is moving in the direction of the Abeta plaque removal or prevention of their formation, but NONE of these drugs have managed to slow the cognitive decline in test group patients, as I have written in my previous post.

Re:Not just a test benefit

[blind biker]

That said, I feel very much with you, regarding your father's dementia. In this phase (before apathy sets in), AD is a frightening experience for the patient, too, especially if he/she was/is an intellectual worker, such as a researcher or such. Forgetting words that you used commonly, is scary. Forgetting the names of your colleagues is scary. Forgetting the names of your friends is scary. It's not easy. Then, at the more severe stage, the patient becomes apathetic and then, I guess, it's easier for him/her.

I wish you, with my whole heart, that a cure for AD is found before it's too late for your father.

Re:Not just a test benefit

[thePowerOfGrayskull]

Heck with that - let's first wait until the paper is peer-reviewed.

Re:Not just a test benefit

[priegog]

Unfortunately, it's been known for a number of years now that the histological characteristics of alzheimers were the accumulation of beta-amyloid and the presence of tau protein, so this test is only that, a test, not any significant discovery on the disease itself...

Re:Not just a test benefit

[Eccles]

Thank you for your kind thoughts, but I really do think it's too late for him. For my wife's sake, I hope for one for me. For my mother's sake, I hate to think this way, but... well, I won't say it, just think it.

As a general rule, my father doesn't seem scared, just confused, although he's had a strange paranoia about money. This despite a generous retirement pension/savings/etc.

Re:Not just a test benefit

[blind biker]

I have no idea of the stage in which your father is in, and certainly I have no right to tell you anything. But I think it's always better if you do't give up hope on him, yet. Because if you fight for him as hard as you possibly can, you will know that you'll do it for yourself, too, if and when the time comes.

By the way, have you tried giving him curcumin (curcuma extract)? There appear to be more and more articles in journals (such as Journal of Neurochemistry) that describe almost immediate benefits to AD sufferers, after administering large doses (several grams / day) of curcumin.

Requires a spinal tap

[Meshach]

From TFA:

One drawback, though, is that spinal fluid is obtained with a spinal tap, and that procedure makes most doctors and many patients nervous. The procedure involves putting a needle in the spinal space and withdrawing a small amount of fluid.

I know that more education is needed in this area. Any thing involving the back is inherently risky. The wikipedia article indicates. that well the risk is low it is a major procedure and not many people will be comfortable in having one for just a test.

Potentially huge problem with the test

[blind biker]

Amyloid-beta plaques are not a necessary condition for Alzheimer's. I don't know, of course, the details of this latest cerebrospinal fluid test, but the previously published one was only looking for traces of Abeta peptides. If the claim of 100% accuracy is actually true (we have to see the article), then it perhaps also takes into consideration tau protein traces. I am really just speculating here, but tau protein tangles seem to be clearer indicators of Alzheimer's disease.

Many people have been found to have Abeta plaques in their brain tissue without having any cognitive loss. And drugs that remove or prevent the formation of Abeta plaques have NOT proven to be efficient in slowing down the progress of AD. I am puzzled at the hundreds of millions of $ spent by big pharma developing and testing drugs that combat Abeta plaques, when none of those drugs has shown any statistically significant cognitive improvements in AD patients.

Re:Potentially huge problem with the test

[PatrickThomson]

Amyloid beta was there and it was targetable by the methodology available to drugs companies. Now, they've discovered it doesn't work, and there's a few years of lag time between findings synchronising. I don't think there are any more gamma-sec or beta-sec programs in drug discovery. Let's just hope there's another target around.

Re:Potentially huge problem with the test

[blind biker]

Virtually all current Phase III evaluations center on Abeta. Sadly.

Re:Potentially huge problem with the test

[PatrickThomson]

I'm a chemist and I've worked on a gamma-sec modulator, so I see it from the bottom up. Drugs might be in human trials but I don't think there's any new discovery programs.

Re:Potentially huge problem with the test

[blind biker]

I'm extremely happy to meet someone "on the inside". Can you please tell me, in your personal but informed (much more informed than mine, anyhow) opinion, what is the most likely candidate for a decisive cure for AD, currently being researched?

Re:Potentially huge problem with the test

[PatrickThomson]

I only made the molecules and I saw a tiny corner of the industry as it was in 2008. I have general common sense in the field but I really can't say without it being my opinion.

The current thrust has always been about targeting a specific symptom (the plaques) but my feeling is that even if we get a working aB42 inhibitor, it won't stop senility. I read a few years ago about a preventative treatment that halted cognitive decay, based on a substituted ibuprofen, but I can't recall of any of the details.

no kidding

[RelliK]

The spinal needle goes up to 11 (inches).

Re:no kidding

[Anonymous Coward]

FTA: because most family doctors and internists are not experienced with the test, there could be special spinal tap centers where they could send patients.

Paging Dr. Nigel Tufnel!

wtf

[Anonymous Coward]

Didn't RTFA (standard) - what the hell does 100% accuracy mean? No false positives and no false negatives? *Bullshit*

Does knowing early help?

[RabbitWho]

There's no treatment for it and nothing they can do. I'd rather not know for as long as possible, you start going crazy as you watch yourself deteriorating every day. If I forget and put door keys in the microwave I think "oh I'm such an idiot." and laugh. I don't feel the terror that someone with Alzheimers feels, thinking every mistake is a sign.

Re:Does knowing early help?

[olsmeister]

While I tend to agree with your position, there are many who would want to know, particularly if there is a family history of this disease. It might affect your planning for the future, and even the way you live your life today.

Re:Does knowing early help?

[phantomfive]

Watching my grandpa suffer through Alzheimer's, this is a real issue. At first he took it with a sense of humor, when I called he'd say, "hey, I almost forgot about you! Call more often!" But soon I could see it was really getting to him, and he was starting to withdraw into that stupor that people get into at convalescent homes.

So I forced him to be active; when he tries to tell me something, and can't think of the word, I just wait for him to spit it out, or tell him to explain it a different way. Get him active, help him see that life can be good even though he doesn't remember quite as well. I treat him like a human and make him connect to me like a human. No withdrawing into that shell just because you can't remember well. I took him to see giant trees and waves and stuff. Giant trees and waves always make you feel alive.

So now he is happier, got over his anger streak, and he doesn't worry if he can't remember everything (it doesn't matter if you can find a way to work around it).

Re:Does knowing early help?

[interkin3tic]

To an individual, maybe not, but for drug trials, yes. Knowing definitively that your test subjects had the disease or did not would be better than judging by symptoms. I'd also wager that there are probably a few other non alzheimers problems that show similar symptoms early on, it would be valuable to know if it was AZ or not AZ and instead might be a brain tumor, for example.

Re:Does knowing early help?

[Anonymous Coward]

Thank you for sharing your experience. I was too young to do much for my grandfather, but all his children treated him like an invalid and continued to be disrespectful and borderline insulting as his Alzheimer's continued. They refused to help him and he became quite destructive in his angry phase, until he was too physically weak to fight and was by then in a home. I think because he was abusive to them in their youth, they used his illness as a chance to get back knowing he couldn't do much.

I wish they treated him as you have treated your grandfather. What you are doing is wonderful and I applaud you and him for making the best of a difficult situation.

Re:Does knowing early help?

[RabbitWho]

I guess there are a lot of things that can make it easier to deal with, but there is nothing that can slow it down or stop it.

It's great to read your experience with your grandfather, you must be a great comfort to him.

Re:Does knowing early help?

[dr_dank]

There's no treatment for it and nothing they can do. I'd rather not know for as long as possible, you start going crazy as you watch yourself deteriorating every day.

And to think we used to cluck our tongues at the people who ate badly, smoked, drank, etc who died of a coronary at 60-70. Now you can live to 90 and be a vegetable. Hooray.

Until the mind can be prolonged the same way medicine has prolonged the body, it's all for nothing.

Re:Does knowing early help?

[RabbitWho]

Of course it's not "all for nothing". Not everyone gets Alzheimers, strokes and brain tumours.
Ordinary dementia can be fought tooth and nail by reading/listening to the radio/watching television/having friends and family around you.

My grandfather lived to be 87 and was sharp as a tack right up until the day he died.

Re:Does knowing early help?

[phantomfive]

Yeah, I know that's true, but I'm going to make sure his memory he does lose is from alzheimer's, and not from some old-age malaise!

Re:Does knowing early help?

[Ironhandx]

Shit, all my grandfathers children are treating him like a borderline invalid now, and he's still in good shape. I took him out cutting wood for a few weeks winter before last. Sure he can't do as much as he used to, but not being treated like an invalid and doing something useful for a few weeks... the poor guy looked better for months afterwards than he had for years previously.

Seriously though, a man that can still safely swing a chain saw plus haul the logs he cut(all but the biggest, some of which I couldn't even move without further segmenting) is far from an invalid. I personally think this is a very widespread flaw in the current 30-60 generation in regards to their parents. I guess a lot of the 40-60 crowd led cushier lives and already can't do a lot of what their parents still can at 60-80+. I know thats a lot of the reason my grandfathers children treat him like an invalid. They basically look at it and go "Shit, I can't even begin to do that, theres no way its even safe for him to try!" Meanwhile he'd run circles around them.

I'm currently looking for a good part time job for him(something suitable, similar to what he did all his life, but of course without too much back breaking labour, he is in his 70's) just to get his spirits up. People don't understand it, my own generation included, but sometimes people are happier when they're WORKING. Not everyone digs the "Get as much money saved as I can so I can be as lazy as possible for as long as possible" lifestyle. My grandfather retired at 65 because the family basically forced him to. He wouldn't have if it was his choice.

Obviously his situation isn't going to be the situation of every other older person out there. If you've got one of those age related bone diseases or develop heart problems... things like that, then obviously for your own health you can't do what you've always done. Otherwise... people should just be more supportive and let folks do whatever the hell they want to do.

One other pet peeve of mine is that people complain that "Oh but that 65 year old man/woman doesn't need to work, they're taking a job away from a young person just starting out!". Well let me be the first one to say, if you're 15-25 and you can't out work a 65 year old its time to put down the god damn cheetos and get off the couch.

Sorry for going a bit far off topic, but back on topic: My grandfather is in a high risk group for developing a particularly nasty brand of alzheimers, and one of the most effective methods of keeping it at bay is exercise, so it really hits home for me when people mention this sort of thing, and pisses me off to no extent at the rest of my family.

Re:Does knowing early help?

[Antique Geekmeister]

Yes, let's leave you not knowing and continuing to drive, or forget what checks you've signed, or whether your spouse is allergic to peanuts when you make her a sandwich, and leave you without a chance organize your finances, any insurance, and a living will for a years long debilitating illness.

Then you can get promoted to middle management, where you can cut costs by discarding that "unnecessary testing".

Re:Does knowing early help?

[misexistentialist]

Currently the correct treatment is suicide. Early knowledge is very important, because later when the suffering really begins for you and your family, you will be helpless. You might argue that one could exit too soon, but a good death can't really be too early.

Re:Does knowing early help?

[RabbitWho]

Suicide is more painful for the family, believe me.

Re:Does knowing early help?

[misexistentialist]

If they really would enjoy smothering you with a pillow, I suppose you could give them that as a parting gift.

Excercise

[neorush]

There is a bunch of research out there pointing out that proper exercise can reduce your risk for Alzheimer's and other forms of dementia by something like 70-75%. So its great there is a test and all, but you can still effect the outcome SIGNIFICANTLY with your lifestyle choices. There is also a link to fruits / vegetable intake as well.

What's the benefit for general use? -- Why do it?

[sgent]

This is an expensive test with a fairly high side effect profile. On top of which, a positive result leaves the doctor and patient with no change in treatment options. Since Alzheimer's is an uncureable disease, early diagnosis doesn't accomplish anything. Neuro-Psychological tests (DRS-2) have very high accuracy in diagnosing the disease in late-early and moderate staged disease. The real question is... we have a positive (or negative) result, so how does this change our proposed treatment. The answer is it doesn't.

That being said, this is a significant advance for research purposes, which should allow for double blind studies without needing an autopsy.

100% is not 'nearly all'

[BitZtream]

Good job guys

I can't wait to see if I will be getting alzified

[bagboy]

I'm looking forward to committing the pillage and plundering knowing I won't have to remember the consequences afterward...

I have a feeling...

[Anonymous Coward]

...there will be a lot of DUPES for this article!

Re:I have a feeling...

[binarylarry]

This is about Alzheimer's, not retardation.

Re:I have a feeling...

[Siridar]

This is about Alzheimer's, not retardation...

I'd like to concur with previous posters.

[EnsilZah]

It may be a useful test but watching This Is Spinal Tap is a painful experience and should be avoided if at all possible.

knowledge is power

[circletimessquare]

and power is um... pancakes

Re:knowledge is power

[Anonymous Coward]

mmmm.... pancakes

They need a test for faggots

[Anonymous Coward]

That way we can kill them before they're even born.

From someone that lost his mother to Alzheimer's

[pgmrdlm]

I don't know if this is good or not. Please let me explain.

If you have ever had the misfortune of having a relative with Alzheimer disease, you know they are nothing like the person you loved and cherished. Everything from forgetfulness, to wanderings where you search the streets for them, to the extreme mood swings where they get violent. Its a terrible experience for both you and the people that have this disease.

If you are diagnosed with this disease in advance, and there are no cures? How do you tell your family and friends? What are you going to think about the pain you know that you may be putting them in?

Knowing how my mother became with this disease, if I find out that I have it and there are no cures. I don't want to put my friends and family through the same experience. I would rather drive my car into a wall at 120 miles an hour.

Just my perception, sorry.

Re:Und this affects NERDLINGS how?

[flydpnkrtn]

Now I have Karen Carpenter stuck in my head you insensitive clod!

No thanks

[Anonymous Coward]

No thanks. This reminds me of the "definitive test" for gout. How does that go? You stick a needle in the (likely already inflamed) joint and draw out some fluid. Then, you look under the microscope for uric acid crystals, which have a recognizeable shape. Needless to say, I've never heard of anybody actually getting this test.

Instead, they just monitor your blood uric acid levels and give you gout drugs. Taking the blood uric acid level is less reliable, but probably an order of magnitude less painful.

Given that Alzheimers is much more serious, perhaps knowing that this is a reliable indicator will lead to a clue, or a less invasive test. Maybe they'll be able to give you something benign that crosses the barrier, binds to those molecules, and shows up on an MRI. Until then, for most of us, it's not going to make a difference.

So what's the point?

[jewishbaconzombies]

So great - you'll know if you're doomed. That sounds like fun.

I'd rather see more data on a cure before I'm supposed to invest myself psychologically in the diagnostics. I've heard things being developed, and ways to help prevent, but living a life with a lit fuse running into your skull doesn't sound like a miracle of medicine - it sounds like a death-clock at the least, and a suicide watch at the most.

Count me out.

thanks

[marketmpb]

Thats a great finding, congrats! It gives us hope against this awful disease.... for a marketing blog that is sexy and funny, check out.. marketmpb.blogspot.com matt

Re:From someone that lost his mother to Alzheimer'

[Anonymous Coward]

Haivng worked in a nursing home for elderly people when I was younger, I agree. If I was starting to suffer from mild cognitive impairment (a common precurser for dementia of different types) then, no, I would not want this test. What's the point? They can't cure it. Sure you can settle your affairs, but there's probably 10 years or so till you die so it's a bit too far in advance to known sit and mope over the fate that awaits you. But too soon to kill yourself.

New test with 100% diagnosis of Alzheimers

[mbreitba]

I have found a non-intrusive test that is 100% accurate in identifying patients with significant memory loss. http://www.toysrus.com/product/index.jsp?productId=2264802&CAWELAID=107512504

Oh, really!

[Anonymous Coward]

The test confirms what is already known? What a tremendous breakthrough! Real Nobel Prize stuff... NOT.

Lumbar puncture

[Vahokif]

Is there any sense in doing a rather nasty test for a disease we can't cure yet anyway? It's not like you can fix it if you find out early.

Re:From someone that lost his mother to Alzheimer'

[hmmm]

At least it would give you some time to prepare, both yourself and your loved ones. If I found I had Alzheimers, I would want to make sure that I enjoyed the next few years and ensured that my family were taken care of. I'm sure depression would accompany a diagnosis, but for many people the certainty of knowing is ultimately a relief.

"100 percent accurate" vs "Nearly every person"

[RichiH]

How I love Slashdot summaries.

Spinal Taps suck

[Wyatt Earp]

I've had 38 spinal taps, 36 of them under local, and everyone was a terrible experience.

Wait for a test that doesn't require the tap.

HealthNewsReview gives NYT 2 stars

[Anonymous Coward]

The article received only 2/5 stars from HealthNewsReviews.
Check it out:

http://www.healthnewsreview.org/review.html?review_id=3055