S03E68 - AD-Detect: Is This the Early Alzheimer's Test We Need?

How valuable would it be to know you were going to develop Alzheimer's disease, even before the symptoms started? AD-Detect, a new consumer test from Quest Diagnostics, available without a prescription, alleges to pick up on the earliest signs of Alzheimer's with a simple blood test.

Let's look at whether this test can actually help us pick up on the disease even earlier than before, or if AD-Detect raises more questions than answers for patients.

And for our weekly thankful - a special body part on a very special person!

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S03E68 - AD-Detect: Is This the Early Alzheimer's Test We Need?

[00:00:00] Sam Rhee:

Alzheimer's disease. If you know anyone who has it, you know how awful the progressive suffering can be. Not only for the person afflicted, but for the families as well. It's estimated that more than 6 million Americans have Alzheimer's disease. And that number is expected to grow to 14 million in 40 years.

And there is no cure. It is the fifth leading cause of death in Americans over the age of 65. But what if you could detect Alzheimer's disease before you even start to have symptoms, so you could prepare and manage your disease better? There's a new blood test called AD Detect from Quest Diagnostics that you can buy today without a prescription, which claims to help consumers know what their potential risk of developing Alzheimer's disease would be in the future.

For people who have family members suffering from Alzheimer's this test may be the potential knowledge that they would want since genetics does play a role in developing the disease.

How helpful would it be for a son or daughter to know that they may develop the disease after dealing with the devastating ordeal of caring for their parents?

As someone who has a family member who's starting to experience some serious memory loss, I wanted to see if this test was something useful for them as well as for me. So let's take a look at this new Alzheimer's disease test and see if the results are helpful or if it raises more questions than answers.

First of all, as always, remember that I'm going to open by reminding people that I am talking about my own personal experiences and I'm not giving medical advice as your physician. This show is not a substitute for professional medical advice, diagnosis or treatment.

This show is for informational purposes only. Always seek the advice of your qualified health provider with any questions you may have regarding medical care and never disregard professional medical advice or delay seeking advice because of something in this podcast.

Okay, so we all know about Alzheimer's disease, but what is it exactly? To steal from Wikipedia, Alzheimer's disease is a neurodegenerative disease that usually starts slowly and progressively worsens. Protein deposits known as amyloid plaques and tangles accumulate in the brain until neuronal connections are lost. Issues with memory, language, orientation, and behavior worsen until there is near complete loss of brain function and death occurs.

Typically, life expectancy is between three to nine years after the initial diagnosis. The cause of Alzheimer's appears to be multifactorial. There are known environmental and lifestyle risk factors such as history of head injury, or clinical depression, chronic sleep disturbances, diabetes, smoking, or high blood pressure.

There are also genetic risk factors for Alzheimer's. 1-2 percent of Alzheimer's cases are purely inherited, in which early onset Alzheimer's definitely occurs due to very specific gene mutations. However, in most cases over the age of 65 years old, the cause of Alzheimer's disease is a complex combination of multiple genes as well as these lifestyle and environmental factors.

Diagnosing Alzheimer's disease formally is an intensive process. It usually starts with the patient or those around them noticing mental signs such as memory loss, poor judgment, losing track of dates or locations. Physicians then evaluate the patient with neurologic exams, functional assessments and brain imaging, or spinal fluid examinations.

There is no cure for Alzheimer's, although there are supportive measures. In addition, however, there is a new drug this year, Leqembi, which can slow progression of Alzheimer's. This is only for patients with early stage disease. Studies have shown that this monoclonal antibody drug helps remove plaques in the brain, which can decrease expected declines in memory and thinking by 30 percent over 18 months of treatment in early cases.

Since the process of formally diagnosing Alzheimer's is a rigorous process and knowing that there's a new early drug for the disease, it is understandable that there may be many consumers out there that might be interested in a simple blood test that helps them to figure out if they may be at a higher risk for developing Alzheimer's or diagnosing the disease even before the mental signs start occurring.

So, at the end of July of this year, Quest Diagnostics in Secaucus, New Jersey announced that they have the first blood test to help assess the risk of developing Alzheimer's disease. Called AD Detect, this test costs $399.

Patients then go to a Quest service lab where they have their blood drawn. And patients then receive the results online, and if they wish, they can discuss these results via telemedicine with an independent physician referred by Quest Diagnostics.

So what does this test check for? This AD Detect test evaluates the plasma levels of amyloid beta proteins, which are the proteins that accumulate and cause these brain plaques.

Specifically, it checks the ratio between two types of amyloid beta proteins. And studies have shown that a certain ratio of these two types of amyloid protein is associated with Alzheimer's disease.

So the million or multi million dollar question is, does this test work? And the initial answer right now is, maybe not so great. At least not the way the test appears to be set up. First of all, this AD Detect test is not FDA approved. While FDA approval is the gold standard for diagnostic tests, companies don't need FDA approval to market and sell their tests.

So far the publicly available research data from Quest Diagnostics is pretty sketchy.

According to the website AlzForum.org, there is no peer reviewed published data. The only data out there is a research poster presented at the 2022 Alzheimer's Association International Conference, which showed out of a test group of 209 people, this AD Detect test was only 89 percent sensitive, meaning it correctly identified 89 percent of people who were positive, but missed 11 percent of the people who actually had Alzheimer's amyloid protein ratio.

This test was also only 71 percent specific, meaning out of all the patients who didn't have this, 29 percent erroneously tested positive. So typically diagnostic tests are supposed to be at least 90 percent sensitive and 90 percent specific to be useful.

Meaning they should catch at least 90 percent of the people with the disease and the test should have less than 10 percent false positives, where the people without the disease are erroneously marked positive. So, based on this initial data, this is far from that standard.

11 percent of these people tested will think they don't have Alzheimer's when they actually do. And 29 percent of the people tested who don't have the disease will accidentally be told that they do have the disease. So, the only thing worse than knowledge is false knowledge. The needless fear and anxiety that a false test raises, or worse, thinking you don't have Alzheimer's when you actually might have it could result in patients embarking on useless treatments or even worse, delay seeking treatment.

In addition there's also the concern that a positive test may disqualify patients from long term care insurance. This is already a problem with many genetic tests out there.

So for right now for people who don't have any symptoms at all for Alzheimer's, there's no reason right now to get this blood test, even if you have strong family history or other concerns. The potential issues with the accuracy of this blood test is enough to deter me from using it alone, as well as to know what to do with the results themselves without any signs or symptoms.

Now, however, if you are having what you might think are early symptoms of Alzheimer's, the right thing to do is to see your physician. This blood test, even in its questionable early state, could certainly be helpful if it is done in conjunction with other testing. But having the proper consultation advice is critical to know what to do with this result.

And shame on Quest Diagnostics for jumping the gun without proper published data and proof of an accurate test in what I think is an attempt to cash in on the fears of patients out there.

Get your FDA approval, Quest Diagnostics and then work with providers to help patients, not profit from their unwarranted fears. I hope Quest Diagnostics does the right thing for patients in the future, not just for their bottom line.

So my thankful this week is a leg, as in lower extremity. Actually not all legs, but a specific leg attached to a specific person. And that specific person is New York Jets kicker Greg Zuerlein, also known as Greg the Leg or Legatron. Last Sunday, the Jets beat the Eagles for the first time in franchise history 20-14.

And when you see the recap and post game discussion, you'll hear about how awesome the Jets defense was, which they were, the poor decision making by the Eagles quarterback Jalen Hurts, which it was, and the just good enough performance by Jets quarterback Zach Wilson and the offense, which hopefully will continue to improve.

But little mention was made of the four field goals that Greg Zuerlein made which kept the Jets in the game, from 43, 42, 35, and 38 yards. It was only in the last two minutes that the Jets finally scored a touchdown. And after watching other games this weekend where there were not just a few questionable kicking performances, you have to appreciate how talented and consistent Greg The Leg is.

He has 14 of 15 made field goals for the season. And the week before, he actually made 5 of 5 field goals in the win against the Denver Broncos as well. So here's to the unsung heroes of football that actually look the most like the rest of us average athletes.

And hopefully the Jets offense will be better in the red zone and give the Legatron a little bit of rest in the upcoming games.

So what body part do you appreciate either on yourself or someone else? As always DM me @BotoxAndBurpeesPodcast on Instagram, or leave a comment at YouTube.com/@BotoxAndBurpees.

Thank you.