The only thing I know

Alzheimer’s disease has barely been around more than a century.

It was first discovered by German psychiatrist Alois Alzheimer 1907.

Of course, that doesn’t really mean the disease is really only 100 or so years old. America was only discovered in 1492. But it had existed for millennia before that.

Still, giving something a name makes it real. And in terms of medicine, it means people can study, treat and hopefully cure it.

The thing is, it’s proving extremely difficult to study, treat and cure. It’s still not even clear what the cause is.

From Scientific American:

The long-standing amyloid hypothesis posits that symptoms are triggered by the buildup of amyloid beta brain plaques, but trials of drugs that attempt to clear these plaques have so far flopped. Skeptical researchers have hunted for other explanations, and some have zeroed in on microbes.

Over the last few years, more and more studies have linked Alzheimer’s with viral infections, namely certain strains of herpes.

And in February this year Tzeng et al. and published a paper in Neurotherapeutics linking HSV1 – the virus that causes cold sores – to Alzheimer’s.

It was far from the first paper making this link. But it was one of the most exhaustive. And one of the few to offer hope.

Antivirals can reduce people with herpes’ chances of developing Alzheimer’s by 90%

The study had 33,448 participants, and ran over 18 years.

It found that “patients with HSV infections may have a 2.56-fold increased risk of developing dementia.”

But also that those with HSV were 90% less likely to develop dementia if they were treated with antiviral drugs.

And according to commentary on the study by University of Edinburgh professor Richard Lathe:

Not only is the magnitude of the antiviral effect remarkable, but also the fact that – despite the relatively brief duration and the timing of treatment – in most patients severely affected by HSV1 it appeared to prevent the long-term damage in brain that results in Alzheimer’s.

So, if you suffer from cold sores, it looks like getting a course of antiviral drugs during your next outbreak could be a very good idea.

And there may even be hope on the horizon for people who already suffer from Alzheimer’s.

And that’s a good thing. Because between 2000 and 2014 deaths from Alzheimer’s increased by 89%.

Right now, “it is the only cause of death among the top 10 that cannot be prevented, cured or even slowed,” according to data from the Alzheimer’s Association.

A potential cure for Alzheimer’s emerges

Against that stark background, a new study covered in this New York Times article last Wednesday could help huge numbers of people.

It begins:

The long, discouraging quest for a medication that works to treat Alzheimer’s reached a potentially promising milestone on Wednesday. For the first time in a large clinical trial, a drug was able to both reduce the plaques in the brains of patients and slow the progression of dementia.

It was a wide-ranging study, with 856 patients from around the world, and it can essentially be summed up with this excerpt:

“This trial shows you can both clear plaque and change cognition,” said Dr. Reisa Sperling, director of the Center for Alzheimer Research and Treatment at Brigham and Women’s Hospital in Boston, who was not involved in the study. “I don’t know that we’ve hit a home run yet. It’s important not to over-conclude on the data. But as a proof of concept, I feel like this is very encouraging.”

The annoying thing about the article is that it didn’t provide any links to the actual study. So today I decided to try find out more about it by googling the name of the drug: BAN2401.

And unfortunately, as ever, more research muddies my ability to draw any clear conclusions.

You know nothing, Jon Snow

This Fortune article was published between when I started writing this piece, around an hour ago, and now.

It writes about how many different outlets reported on the results of the study differently. Some hugely positive, some hugely dismissive.

It turns out the study did well on two, new methods of assessing cognitive ability and mental function, but did no better than a placebo using a more established method.

So, take one set of results and it’s miraculous. Take another and it’s no better than a sugar pill.

But this wasn’t the only thing the study had going against it. As the Fortune article writes:

Biogen and Eisai [the companies behind the study] may have also shot themselves in the foot by announcing early in July that they had “positive” results—allowing their stocks to soar—while leaving the not-so-clear details to be sorted out later.

And even worse:

The research team began with one statistical analysis— then seemed to change their mind when it didn’t deliver the goods. That’s how an investigative agent could appear ineffective after a year, but curiously effective just six months later.

Adding to this:

The share of people with a major risk factor for Alzheimer’s was much smaller in the pivotal drug arm than it was in the group getting placebo. That decision was due to European regulators, not to the companies, who were concerned that patients with this particular genetic susceptibility would also be at greater risk of brain injury if they received the drug. But it also may have inadvertently skewed the results

So, you can see why this study has been reported completely differently by different outlets.

I started out thinking essay would be a hope story about a potential Alzheimer’s treatment. But it’s once again descended into me dissecting narratives from different sources, which have different angles to push.

Perhaps the study really does show promise. But as usual, we’ll know at a later date.

This is yet another reminder to never get your news and research from just one source.

Everyone is, consciously or not, pushing their own narrative. The truth is probably somewhere in between.

Again, and again while writing Exponential Investor, I’m reminded of Socrates’ famous saying: “The only thing I know is that I know nothing.”

That, and the the modern-day equivalent, ever repeated by Ygritt in Game of Thrones: “You know nothing, Jon Snow.”

Until next time,

Harry Hamburg
Editor, Exponential Investor

Category: Genetics and Biotechnology

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