Health
Blood tests for Alzheimer's may be coming to your doctor's office: What to know
- New blood tests show promise for faster and more accurate diagnosis of Alzheimer’s disease, medical researchers say.
- Many current Alzheimer’s diagnoses are based on symptoms and cognitive exams, but blood tests could offer a simpler alternative.
- Blood tests measuring p-tau217, a biomarker associated with Alzheimer’s, are expected to become more prominent as FDA guidelines are established.
New blood tests could help doctors diagnose Alzheimer’s disease faster and more accurately, researchers reported Sunday – but some appear to work far better than others.
It’s tricky to tell if memory problems are caused by Alzheimer’s. That requires confirming one of the disease’s hallmark signs — buildup of a sticky protein called beta-amyloid — with a hard-to-get brain scan or uncomfortable spinal tap. Many patients instead are diagnosed based on symptoms and cognitive exams.
Labs have begun offering a variety of tests that can detect certain signs of Alzheimer’s in blood. Scientists are excited by their potential but the tests aren’t widely used yet because there’s little data to guide doctors about which kind to order and when. The U.S. Food and Drug Administration hasn’t formally approved any of them and there’s little insurance coverage.
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“What tests can we trust?” asked Dr. Suzanne Schindler, a neurologist at Washington University in St. Louis who’s part of a research project examining that. While some are very accurate, “other tests are not much better than a flip of a coin.”
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More than 6 million people in the United States and millions more around the world have Alzheimer’s, the most common form of dementia. Its telltale “biomarkers” are brain-clogging amyloid plaques and abnormal tau protein that leads to neuron-killing tangles.
New drugs, Leqembi and Kisunla, can modestly slow worsening symptoms by removing gunky amyloid from the brain. But they only work in the earliest stages of Alzheimer’s and proving patients qualify in time can be difficult. Measuring amyloid in spinal fluid is invasive. A special PET scan to spot plaques is costly and getting an appointment can take months.
Even specialists can struggle to tell if Alzheimer’s or something else is to blame for a patient’s symptoms.
“I have patients not infrequently who I am convinced have Alzheimer’s disease and I do testing and it’s negative,” Schindler said.
New study suggests blood tests for Alzheimer’s can be simpler and faster
Blood tests so far have been used mostly in carefully controlled research settings. But a new study of about 1,200 patients in Sweden shows they also can work in the real-world bustle of doctors’ offices — especially primary care doctors who see far more people with memory problems than specialists but have fewer tools to evaluate them.
In the study, patients who visited either a primary care doctor or a specialist for memory complaints got an initial diagnosis using traditional exams, gave blood for testing and were sent for a confirmatory spinal tap or brain scan.
Blood testing was far more accurate, Lund University researchers reported Sunday at the Alzheimer’s Association International Conference in Philadelphia. The primary care doctors’ initial diagnosis was 61% accurate and the specialists’ 73% — but the blood test was 91% accurate, according to the findings, which also were published in the Journal of the American Medical Association.
Which blood tests for Alzheimer’s work best?
There’s almost “a wild West” in the variety being offered, said Dr. John Hsiao of the National Institute on Aging. They measure different biomarkers, in different ways.
Doctors and researchers should only use blood tests proven to have a greater than 90% accuracy rate, said Alzheimer’s Association chief science officer Maria Carrillo.
Today’s tests most likely to meet that benchmark measure what’s called p-tau217, Carrillo and Hsiao agreed. Schindler helped lead an unusual direct comparison of several kinds of blood tests, funded by the Foundation for the National Institutes of Health, that came to the same conclusion.
That type of test measures a form of tau that correlates with how much plaque buildup someone has, Schindler explained. A high level signals a strong likelihood the person has Alzheimer’s while a low level indicates that’s probably not the cause of memory loss.
Several companies are developing p-tau217 tests including ALZpath Inc., Roche, Eli Lilly and C2N Diagnostics, which supplied the version used in the Swedish study.
Who should use blood tests for Alzheimer’s?
Only doctors can order them from labs. The Alzheimer’s Association is working on guidelines and several companies plan to seek FDA approval, which would clarify proper use.
For now, Carrillo said doctors should use blood testing only in people with memory problems, after checking the accuracy of the type they order.
Especially for primary care physicians, “it really has great potential to help them in sorting out who to give a reassuring message and who to send on to memory specialists,” said Dr. Sebastian Palmqvist of Lund University, who led the Swedish study with Lund’s Dr. Oskar Hansson.
The tests aren’t yet for people who don’t have symptoms but worry about Alzheimer’s in the family — unless it’s part of enrollment in research studies, Schindler stressed.
That’s partly because amyloid buildup can begin two decades before the first sign of memory problems, and so far there are no preventive steps other than basic advice to eat healthy, exercise and get enough sleep. But there are studies underway testing possible therapies for people at high risk of Alzheimer’s, and some include blood testing.
Health
Words and game of Scrabble keep married couple in wedded bliss for decades
A married couple who have long enjoyed the game of Scrabble both together and separately before they even met are never at a loss for words — and attribute their wedded bliss in part to their love of the nostalgic game.
They’re still playing in tournaments built around the game decades after they began doing so.
Graham Harding and his wife Helen Harding, both in their 60s, have been married for over 20 years.
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They met in the 1990s at Scrabble tournaments, as news agency SWNS reported.
But it was a “special match” in 2000 that brought the couple together — and has kept them together now.
Graham Harding is from the East Berkshire Scrabble Club, while his wife Helen is from the Leicester Scrabble Club in the U.K.
They have been taking part in the UK Open Scrabble Championship in Reading this week.
“The more words you know, the more ammunition you’ve got.”
“Scrabble is all about having a good vocabulary,” said Graham Harding, SWNS noted.
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“But it is a Scrabble vocabulary — not necessarily everyday English.”
Added Helen Harding, “The more words you know, the more ammunition you’ve got.”
The couple said they were “vague acquaintances” for about five years after they first met.
Then they got together after a special match in Swindon.
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They maintained a long-distance relationship before they got married in 2004.
The couple even brought their Scrabble board to their wedding.
It featured a message with Scrabble pieces that said, “Congratulations on your wedding day” — while their wedding cake said, in Scrabble letters, “Helen and Graham.”
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They each took up the hobby early in life well before they met each other.
The tournament that’s been taking place this week is the first since the COVID pandemic after a five-year break — and the couple has played some two dozen games in it as of Friday, SWNS reported.
Health
Deep sleep can keep two big health problems at bay, new studies suggest
It might be worth working a little bit harder to get that much-desired, but often elusive, good night’s sleep.
Deep sleep clears the mind of waste just as a “dishwasher” cleans dirty plates and glasses, just-published research suggests — and there’s more.
The findings also offer insights into how sleeping pills may disrupt the “brainwashing” system — potentially affecting cognitive function for people over the long run.
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Study senior author professor Maiken Nedergaard of the University of Rochester and the University of Copenhagen said norepinephrine (a neurotransmitter and hormone) triggers blood vessels to contract — generating slow pulsations that create a rhythmic flow in the surrounding fluid to carry away waste, news agency SWNS noted.
Said Nedergaard, “It’s like turning on the dishwasher before you go to bed and waking up with a clean brain. . . . We’re essentially asking what drives this process and trying to define restorative sleep based on” this “glymphatic clearance.”
The brain has a built-in waste removal process – the glymphatic system – that circulates fluid in the brain and spinal cord to clear out waste, according to the scientists.
The process helps remove toxic proteins that form sticky plaques linked to neurological disorders, such as Alzheimer’s disease.
But the scientists indicated that what drives the system was unclear until now, according to the study.
Is all sleep created equal? The researchers wanted to find out.
To find clues, Nedergaard and her team looked into what happens in mice when their brains sleep, as SWNS reported of the study. The team focused on the relationship between norepinephrine and blood flow during deep sleep.
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They found that norepinephrine waves correlate to variations in brain blood volume — suggesting that norepinephrine triggers a rhythmic pulsation in the blood vessels. The researchers then compared the changes in blood volume to brain fluid flow.
The brain fluid flow fluctuates in correspondence to blood volume changes, suggesting the vessels act as pumps to propel the surrounding brain fluid to flush out waste.
Natalie Hauglund of the University of Copenhagen and the University of Oxford, the study’s lead author, said, “You can view norepinephrine as [the] conductor of an orchestra.”
She added, “There’s a harmony in the constriction and dilation of the arteries, which then drives the cerebrospinal fluid through the brain to remove the waste products.”
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Hauglund said she wanted to understand whether all sleep is created equal.
To find out, the research team administered zolpidem, a common drug to aid sleep, to mice.
“If people aren’t getting the full benefits of sleep, they should be aware of that, so they can make informed decisions.”
They found that the norepinephrine waves during deep sleep were 50% lower in zolpidem-treated mice than in naturally sleeping mice.
Although the zolpidem-treated mice fell asleep more quickly — fluid transport into the brain dropped more than 30%, as SWNS reported.
The researchers say their findings, published in the journal Cell, suggest that the sleeping aid may disrupt the norepinephrine-driven waste clearance during sleep.
Hauglund said, “More and more people are using sleep medication, and it’s really important to know if that’s healthy sleep. If people aren’t getting the full benefits of sleep, they should be aware of that, so they can make informed decisions.”
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The research team said the findings likely apply to humans, who also have a glymphatic system, although it requires further testing.
Nedergaard added, “Now we know norepinephrine is driving the cleaning of the brain, we may figure out how to get people a long and restorative sleep.”
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Meanwhile, a lack of sleep may be doing more damage than just making people groggy.
It could be sabotaging the brain’s ability to keep intrusive thoughts at bay.
Another new study, this one published in the Proceedings of the National Academy of Sciences, found that sleep deprivation weakens the brain’s defense against unwanted memories, allowing them to flood the mind, according to the New York Post.
“We show that sleep deprivation disrupts prefrontal inhibition of memory retrieval, and that the overnight restoration of this inhibitory mechanism is associated with time spent in rapid eye movement (REM) sleep,” the scientists said.
Health
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