The End of Alzheimer's
Posted: Thu Jun 23, 2022 3:54 pm
With all of the emerging powerful AD treatment rapidly approaching it has me thinking about what happens after AD has been conquered.
This motivated me to look at the long term figures for the leading causes of mortality. The three figures below capture most of the leading causes of mortality over the last ~70 years. The bottom figure shows the Big 3: Heart Disease -- Cancer -- Stroke. The middle figure shows some of the middle ~5 "pathological diseases". The top figure shows more the behavioral (Diseases of Desperation) and neurological (AD) leading causes.
It is disappointing in the figures below that certain "modern illnesses" were only all of a sudden recognized as
diseases. For example, AD was only noticed as a disease for reporting purposes in ~2000?
No one had even perceived there was a dementia crisis until then? Similar to what we saw with COPD.
No one realized that there was a respiratory health crisis (largely from smoking) until ~1980?
To avoid such absurdies it would probably be best to give more prominence to a multiple cause of mortality interpretation. While AD might often not be the precise "cause" of mortality in many instances, it would nonetheless be a contextual factor of substantial importance. I think including such broader context to move beyond often statistics devoid of actual human meaning would be of great use in revealing the medical circumstances that people faced. It seems to me to be ludicrous to possibly point to all sorts of peripheral features that might be present with AD mortality for example, bed sores, etc. etc. and somehow see these as causal when clearly AD itself will be the underlying driving features that is dominating the life choices of the person involved. In such a conception of reporting, the true AD presence could be extremely high.
Regarding digital storage. Seriously, we now have a near infinity of digital storage capacity; there is no longer need to worry about all the trees that will need to be clear cut to print out all of the information. Perhaps each person should be allocated 1 megabyte of digital memory to statistically encapsulate their life experience; for medical and other edification.
It would help to inform where research dollars should be directed. Otherwise, you wind up with the discovery of AD in 2000 even though from a multiple causation perspective this would have been obvious for decades. Even now AD is likely highly under-reported in the leading causes as it can be clinically present, though might be largely ignored.
It is also disappointing that there are no examples shown in which a leading cause simply disappears all of a sudden.
One might suspect that with a miracle type breakthrough that would be possible. You find a pill and tomorrow Disease X no longer exists. During the last century this does not seem to have happened. The figures below show more of a 2% decline ... another 2 % decline ..... and then over the space of 30-50 years an illness gradually recedes (for example, heart disease or stroke).
Yet, for Alzheimer's my suspicion is that we will see a dramatic decline in the rate starting possibly within ~1 year. This would be a first. Being able to halt progression (or nearly so ~90% with LMTM) as has been demonstrated should dramatically and rapidly bring AD under control. If progression could be stopped even into the moderate stage, then AD would no longer be a mortality driver. We noticed that even with profound disability the actual impact on health was not that large. Roughly, a 90% decline in the age adjusted rate within 10 years of a first effective AD medication (e.g., LMTM) seems plausible to me. Such a massive rapid decline in a top cause over the last century (in a non-infectious illness) has never occurred before.
This is a very exciting conjecture. As soon as the reports of greatly reduced progression of AD are confirmed (possibly within the next 2 months) we could then project forward to a time in the medium term where AD is no longer amongst the leading causes of mortality and possibly could have almost vanished.
This motivated me to look at the long term figures for the leading causes of mortality. The three figures below capture most of the leading causes of mortality over the last ~70 years. The bottom figure shows the Big 3: Heart Disease -- Cancer -- Stroke. The middle figure shows some of the middle ~5 "pathological diseases". The top figure shows more the behavioral (Diseases of Desperation) and neurological (AD) leading causes.
It is disappointing in the figures below that certain "modern illnesses" were only all of a sudden recognized as
diseases. For example, AD was only noticed as a disease for reporting purposes in ~2000?
No one had even perceived there was a dementia crisis until then? Similar to what we saw with COPD.
No one realized that there was a respiratory health crisis (largely from smoking) until ~1980?
To avoid such absurdies it would probably be best to give more prominence to a multiple cause of mortality interpretation. While AD might often not be the precise "cause" of mortality in many instances, it would nonetheless be a contextual factor of substantial importance. I think including such broader context to move beyond often statistics devoid of actual human meaning would be of great use in revealing the medical circumstances that people faced. It seems to me to be ludicrous to possibly point to all sorts of peripheral features that might be present with AD mortality for example, bed sores, etc. etc. and somehow see these as causal when clearly AD itself will be the underlying driving features that is dominating the life choices of the person involved. In such a conception of reporting, the true AD presence could be extremely high.
Regarding digital storage. Seriously, we now have a near infinity of digital storage capacity; there is no longer need to worry about all the trees that will need to be clear cut to print out all of the information. Perhaps each person should be allocated 1 megabyte of digital memory to statistically encapsulate their life experience; for medical and other edification.
It would help to inform where research dollars should be directed. Otherwise, you wind up with the discovery of AD in 2000 even though from a multiple causation perspective this would have been obvious for decades. Even now AD is likely highly under-reported in the leading causes as it can be clinically present, though might be largely ignored.
It is also disappointing that there are no examples shown in which a leading cause simply disappears all of a sudden.
One might suspect that with a miracle type breakthrough that would be possible. You find a pill and tomorrow Disease X no longer exists. During the last century this does not seem to have happened. The figures below show more of a 2% decline ... another 2 % decline ..... and then over the space of 30-50 years an illness gradually recedes (for example, heart disease or stroke).
Yet, for Alzheimer's my suspicion is that we will see a dramatic decline in the rate starting possibly within ~1 year. This would be a first. Being able to halt progression (or nearly so ~90% with LMTM) as has been demonstrated should dramatically and rapidly bring AD under control. If progression could be stopped even into the moderate stage, then AD would no longer be a mortality driver. We noticed that even with profound disability the actual impact on health was not that large. Roughly, a 90% decline in the age adjusted rate within 10 years of a first effective AD medication (e.g., LMTM) seems plausible to me. Such a massive rapid decline in a top cause over the last century (in a non-infectious illness) has never occurred before.
This is a very exciting conjecture. As soon as the reports of greatly reduced progression of AD are confirmed (possibly within the next 2 months) we could then project forward to a time in the medium term where AD is no longer amongst the leading causes of mortality and possibly could have almost vanished.