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This article soars from hope to hype to skepticism. I guess that's a consequence of reporting on the fringes of science.
In particular, I wish there was more detail on the 100-cohort study where patients experienced "modest improvements" and how that's calculated. Is that average increase of X points on an MMSE, etc.
In my experience in my family, dementia is not a linear slide. My 85yo mother with Alzheimer's will sometimes present very well and you have to really get into conversational details to notice the dementia. On other days, she'll pick up a paperback and try to use it as a phone. Some days she's steady on her feet, some days coordinating all of those muscles is just too much.
Over the course of a couple years, you can track the decline, but it's not a straight line. "Modest improvements" makes me concerned that they measured a valley to a peak. It's only 6 months since the 100-cohort study.
You can click through the reference in the article, the full text of the paper is free:
> The mean MMSE score change were 1.6 at 48 hours (95% CI: 1.079 to 2.158; p < 0.001), 1.25 at 1 month (95% CI: 0.603 to 1.888; p < 0.001), 1.17 at 3 months (95% CI: 0.343 to 2.01; p = 0.004), 1.28 at 6 months (95% CI: 0.311 to 2.344; p = 0.016) after surgery
Derek Lowe's post on this: https://www.science.org/content/blog-post/new-alzheimer-s-th...
I like Lowe but his post doesn't add anything to the discussion unfortunately.
The problem with this stuff is (as the article mentions) is that it’s going to take a while to figure out whether any benefit is just temporary.
I would guess that there are a lot of variables to eliminate too - eg is it possible that just having a surgery and recovering from anaesthesia can yield some of these benefits in some circumstances? Given that we don’t really understand how most inhaled anaesthetics fully work
Yes, indeed.
I've witnessed dementia patients take a fall, and then be dramatically more confused the next couple days. I've also seen them get some kind of social exposure, sunshine, exercise, etc. and present better for several days afterwards. Measuring "how well is the mind working" isn't like reading a digital meter.
re. sunlight, pharmacological immunomodulation via UV isomerization of a substance found on skin is… interesting imo: https://www.pnas.org/doi/10.1073/pnas.0603119103
If anesthetics cured Alzheimer's temporarily then any surgery would get the same effect and we would already know about it.
Firstly it’s not curing anything, it’s yielding some improvement. But secondly: what surgeries are performed on people with Alzheimer’s disease, let alone ones where cognitive improvement is even going to be monitored or noticed afterwards? (and even if it were noticed: periods of lucidity are not rare. It would probably be ignored)
Does it matter if it's just temporary? If it works, it is the smoking gun of what alzheimers is and why it happens. If it is not a permanent fix, the next question is what is happening in the body that is causing these blockages. It also means that microplastics may be a leading cause.
Most likely the build up of those beta amyloid is faster than what the brain can clear by itself. The drainage likely just reduced the amyloid significant enough for the brain to recover. This is likely more of physics explanation than biological. It is similar cleaning the wound by itself has spectacular effect for recovery than you leave it cluttered with dirt and pus.
If you have the money for the surgery, an extra year of cognition is huge. Short-term quality of life improvements are totally worth it if you can afford it.
(Disclaimer: the non-paywalled part of the article did not mention side-effects or complications of the treatment so I don’t know what they are.)
All benefits are temporary, my online friend.
Even if it is temporary, so what? Can't you just repeat it? And wouldn't clearing these drainage channels be harmless (modulo risks of any surgery) even if the theory didn't pan out? If I had early-stage Alzheimer's I'd go to the ends of the Earth and do everything I could to slow it down.
Repeat it? It's not removing a tumor. It's adding a path between lymph nodes and blood vessels. You can't just repeat that. After the surgery that path exists. It's a permanent functional change.
It would be funny if after looking for more complicated causes if much of the Alzheimer's problems were down to bad plumbing. Still I guess a lot of complicated machinery malfunctions if pipes are blocked or the cables are iffy.
As an ML engineer, I improve models through trial and error. Sometimes a change improves my metrics, and other times it makes them worse, and I just revert it and try something else.
It's scary to think about neurological surgery making progress in a similar way. We may not have a good theoretical understanding of why a procedure works, but we observe positive outcomes in a small number of patients and then start looking into expanding its use.
It reminds me of procedures where doctors sever connections between the two hemispheres of the brain to reduce seizures. I've heard they can reduce symptoms, but disrupting connections in the brain can also have unexpected consequences. I hope we can do better than essentially throwing spaghetti at the wall.
We still don't have much of a theoretical understanding of many things in medicine and healthcare, or have since learned that what we thought was a theoretical understanding is grossly wrong. Usually, the only way we can get any closer to such an understanding is by performing what are essentially experiments on people and seeing what happens, particularly people already suffering from horrific diseases and injuries. It may be disturbing and scary in some ways, but that's how things work.
As another MLE who has seen family members go through the disease, I will say the baseline is already pretty bad. So while it would be great to have a complete theory before administering treatments, if it works I’ll take it.
to prevent this "scary" feeling the government should simply mandate that all treatment be done according to set practices never to be deviated from
I wonder if there are multiple causes of Alzheimer’s, and the variability in outcome is due to the fact that the treatment only is fixing one root cause.
That said, if it turns out that a treatment for some Alzheimer’s is some kind of “brain fluid” dialysis, it would be an amazing breakthrough.
Probably
Most conditions are like that, particularly ones where the underlying cause is poorly understood. We see symptoms that lookalike and assume they all point to the same thing
> some kind of “brain fluid” dialysis
i think fixing the plumbing there may be a treatment for a bunch of issues given that for example the whole volume of the cerebrospinal fluid is normally refreshed 3-4 times a day (imagine changing oil in your car engine 3-4 times a day :) - i.e. any hiccup in the plumbing (even a temporarily one and even in the healthy people like a bad sleeping position) and you already may get headache, etc. One can imagine that any chronic performance degradation of the plumbing may lead to a bunch of issues (similar to say what happens in any other organ/limb when blood or lymphatic flow is degraded)
Specifically for Alzheimer's - we do know about direct importance of that plumbing system here - poor sleep is well correlated with Alzheimer's as during deep slow-wave sleep, the brain's glymphatic system actively washes away metabolic waste and toxic proteins, including Alzheimer-related plaques while chronic sleep deprivation increases the buildup of toxic brain proteins like amyloid-beta and tau.
That Alzheimer's surgery brings up another very important and pretty fascinating aspect - not only the Alzheier's may be not permanently damaging the brain, we may speculate that various things we observe as age related brain degradation may be not actual brain cells/core degradation and instead similarly fixable issues of just some utilitarian subsystems.
Alzheimer's isn't one disease, it's a degenerative disease process.
It would be great if it works out, but I believe this treatment has been suspended in China as there are mixed results (ie people have ended up worse).
Being from Scotland I'd trust an NHS evaluation more than random news reports.
But that would suggest that this cures some form of Alzheimer's but not all forms.
If your Alzheimer's is caused by poor drainage due to a one off blockage this would solve it completely, but if its due to something else this would probably just be temporary as the article notes.
Alzheimer's is so devastating that I can't blame people for being willing to give it a go even if it's an experimental treatment.
The government shouldn't be in the business of telling people what they can do, or have done, to their own bodies.
> I believe this treatment has been suspended in China
And the surgeon is in prison according to the article.
I believe it was a mistake to approve anti-amyloid drugs like Aducanumab. Big Pharma threatened to stop research on Alzheimer if they couldn't sell this drug and make bumper profits from it. The FDA should never allow itself to be blackmailed in this manner. If drugs don't show a clear improvement, not just the "slowing of the progression" of the disease (which is infinitely debatable and subject to manipulation), they should be rejected.
The amyloid theory is a dead end, a wild goose chase which has led to tunnel vision and wasted three decades of research into Alzheimer. We're essentially back to square one save for some interesting data that viruses may be involved.
This had led to desperate patients seeking help from charlatans and quacks like the one described in this article.
The ongoing charlatan is the FDA and big pharma for peddling drugs that don't work and even do damage like cause brain bleeds. As for the surgery, everyone knows it is experimental.
I remember hearing the doctor who (I think) discovered these drainage channels being interviewed, it’s super interesting:
https://youtu.be/yAqwXoUS7sE?si=Gs-EGJ_Xtkh9TG7R
If this is correct, it’s a new discovery that these channels exist at all
I wonder what information we have on keeping this drainage system healthy before developing Alzheimer's.
Here's a short video explaining the procedure: https://youtu.be/eRAyu7FWK-E
It would explain problems with treating Alzheimers. Everybody is trying to stop the brain from generating trash that destroys it, which is probably impossible, instead of fixing the trash collection system, existence of we are barely aware of.
Flowers for Algernon
Lots of people look to be trying to cover up and unfairly suppress this treatment. I guess big pharma stands a lot to lose, and they work for them.
I favor trials, of course, but the ones suppressing it would rather just bury it.
Seems like this treatment is widely reported on and there's interest in running controlled trials to evaluate its actual success rate. It's shown up on HN a lot.
And honestly, caution is valuable here. People with Alzheimer's are extremely vulnerable. As are their loved ones. Ensuring it's got rigorous data so caregivers can understand the tradeoffs seems important. Surgery at an advanced age is risky, no matter what.
Hanlon’s razor much?
It seems China is repeating similar mistakes the western world did in the 20th century (e.g. psychosurgery, very weak regulations). It's like watching a car seconds before crash and you can't do anything to stop it.
The article explicitly states:
> The rapid adoption, in the absence of hard evidence, prompted Chinese regulators to intervene. Last year, they restricted the procedure to more-formalized clinical research settings, rather than the ad hoc use that had proliferated previously. And Xie, the pioneer of the technique, has been in detention since September for undisclosed reasons.
There is probably also some benefit to being willing to let some harm come to patients in order to quickly determine if treatments are viable or not. Western medicine puts a premium on human life but development of treatments is certainly slowed by that ethos .
> very weak regulations
Seems you missed out on 10-15 years of development. Regulation strictness these days rival western.
If this works it will be buried so that the pharmaceutical industries can find a pill intervention, no doubt.
Have you seen how many users on this very forum have tried hard to bury it, presumably for the same reason you noted?