
AI Can Detect Alzheimer’s Disease Six Years Before a Diagnosis - laurex
https://www.ucsf.edu/news/2018/12/412946/artificial-intelligence-can-detect-alzheimers-disease-brain-scans-six-years
======
ThePhysicist
Presenting the true positive rate without mentioning false positives seems
problematic. I couldn’t find any information about that in the article, and
they don’t link the paper / publication.

~~~
pge
This is a key point. If the false positive rate is 18% (as noted in other
comments), and the rate of Alzheimer's is 36/100k[1], then for every patient
the test correctly identifies, there are 500 patients that tested positive but
did not have Alzheimers. There needs to be significant improvement before such
a test becomes useful.

[1] that's mortality rate which I am using as a proxy for incidence rate,
though the actual incidence rate is presumably higher (mortality rate from the
CDC)

~~~
bsder
That depends. I suspect that this test would only be used on those with a
family history of Alzheimer's or similar.

That alters the Bayesian priors quite a bit.

In addition, you can monitor the progress of someone who "tests positive" over
time and see if that is really true.

Part of the issue with Alzheimer's treatments is that we may be intervening
far too late. These kinds of tests may help that.

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classics2
Typically Alzheimer’s diagnoses are given with extreme reluctance, it changes
how every person that interacts with that patient will view their condition,
prognosis and treatment options.

I think that has more to do with the extended time frame than the actual
ability of family and medical providers to see changes in a patient cognition
and abilities.

~~~
vegardx
It also triggers a lot of legal implications. In Norway your divorce is
automatically approved if your spouse is diagnosed with Alzheimer's.

~~~
tigershark
Seriously? It seems really inhuman to me.

~~~
criddell
I feel the opposite. If I was unhappy in my marriage and found out my spouse
now also has Alzheimer's, granting a quick exit from a situation that can only
get worse seems humane to me. Why force somebody who is suffering to suffer
even more?

~~~
gjm11
Making it easier to divorce your spouse if they get Alzheimer's is more humane
for spouses of Alzheimer's victims (who get to escape that unpleasant
situation more easily) and more inhumane for Alzheimer's victims themselves
(who are more likely to find themselves abandoned at a time when they are
increasingly unable to cope on their own).

~~~
barrow-rider
> who are more likely to find themselves abandoned at a time when they are
> increasingly unable to cope on their own

That often happens rapidly, and in many cases putting the Alzheimer's patient
in full-time care is the only option -- even with a caring, involved spouse.

I watched my grandfather go from a slightly forgetful goof to confused,
violent, and impossible to manage in <3 years. My grandmother, not doing so
well herself, struggled to keep up but after a couple years putting grandpa in
a facility was the only real tenable option.

~~~
max76
Yes, Alzheimer's patients will eventually need to be placed in a facility.

~~~
bloak
Not necessarily. They might die of other causes first.

There are several things in this discussion that make not much sense to me (a
non-Norwegian):

* How would a divorce court refer to a (confidential) medical diagnosis? In some countries, at least, even a criminal court cannot easily access such things.

* Why would the law refer to a _diagnosis_ of a particular disease (when the patient might still be healthy) rather than refer to actual cognitive impairment?

* What's the hurry? Can't you get a divorce fairly quickly just by moving out and filling in some forms?

* One of the major legal implications of divorce is that you don't automatically inherit or get insurance pay-outs. Not the most obvious thing to want when your spouse has a terminal illness, though in some cases you know there's no money involved. Even if you're named in the will there may be bad tax implications if you're not married to the person you're inheriting from.

* Someone mentioned children, but divorce doesn't have to relate directly to children: courts have to deal with the children of unmarried couples, and they have to deal with the children of couples that are separated but still married, so I'd expect a court to worry about the relationships and the welfare of the children and not to care very much whether the parents/guardians are officially married or not.

I would guess that these are all areas of law in which there are a _lot_ of
differences between jurisdictions.

------
m15i
I'm a co-author of this paper and happy to answer any questions.

~~~
johnnyfived
No questions here, but you guys might be interested to see the implementation
I took with this, where I also used machine learning for Alzheimer's /
dementia diagnosis.

[https://github.com/jddunn/dementia-progression-
analysis](https://github.com/jddunn/dementia-progression-analysis)

I was using OASIS's public dataset so I only had ~150 images to work with,
instead of ~2000. I used transfer learning from ImageNet's dataset to try and
get usable results. I also had super limited testing (15-20 patients), but got
~60% accuracy with ~13% false positive rate.

It could be useful to apply those same transfer learning techniques in your
team's model.

------
jobigoud
> No cure exists for Alzheimer’s disease, but promising drugs have emerged in
> recent years that can help stem the condition’s progression.

What are the downsides of these treatments on a healthy brain? Why are we not
administering them preventively to anyone with a family history of AD?

~~~
vegardx
We are, sort of. We've added lithium to drinking water which has been linked
to decrease in dementia.

People that suffer from bipolar disorder and are being treated with lithium
seems rarely if ever to develop dementia, but the dosages are much much (1000
times, or so) higher than what we add to drinking water.

According to my doctor the primary issue with adding higher concentration of
lithium (still, way below therapeutic levels for mental disorders) to drinking
water is quacks that make a lot of noise when the topic comes up. They see it
as adding mind altering chemicals to water, which couldn't be further from
truth.

~~~
logicchains
According to
[https://www.webmd.com/vitamins/ai/ingredientmono-1065/lithiu...](https://www.webmd.com/vitamins/ai/ingredientmono-1065/lithium)
(presumably about as mainstream a source as one can hope to find online):

"Lithium can cause nausea, diarrhea, dizziness, muscle weakness, fatigue, and
a dazed feeling. These unwanted side effects often improve with continued use.
Fine tremor, frequent urination, and thirst can occur and may persist with
continued use. Weight gain and swelling from excess fluid can also occur.
Lithium can also cause or make skin disorders such as acne, psoriasis, and
rashes worse. The amount of lithium in the body must be carefully controlled
and is checked by blood tests."

"Lithium can poison a developing baby (fetus) and can increase the risk of
birth defects, including heart problems.

Lithium treatment is UNSAFE in women who are breast-feeding. Lithium can enter
breast milk and cause unwanted side effects in a nursing infant.

Heart disease: Lithium may cause irregular heart rhythms. This may be a
problem, especially for people who have heart disease.

Kidney disease: Lithium is removed from the body by the kidneys. In people
with kidney disease, the amount of lithium that is given might need to be
reduced.

Surgery: Lithium might change levels of serotonin, a chemical that affects the
central nervous system. There is some concern that lithium might interfere
with surgical procedures that often involve anesthesia and other drugs that
affect the central nervous system. Lithium use should be stopped, with the
approval of a healthcare provider, at least two weeks before a scheduled
surgery.

Thyroid disease: Lithium might make thyroid problems worse."

Clearly Lithium isn't side-effect free, so it would be pretty reckless to add
something like that to drinking water.

~~~
TaupeRanger
Not at all. The poison is in the dose.

~~~
ethbro
As my pathologist father quipped, 'Everything is poisonous at some bodyweight-
relative dosage.'

------
sameschker
I found the publication that the article discusses.

[https://pubs.rsna.org/doi/pdf/10.1148/radiol.2018180958](https://pubs.rsna.org/doi/pdf/10.1148/radiol.2018180958)

~~~
smartbit
And the full publication can be found by entering
[https://doi.org/10.1148/radiol.2018180958](https://doi.org/10.1148/radiol.2018180958)
into sci-hub.

I often see [https://outline.com/](https://outline.com/) links on HN, does HN
allow sci-hub links?

~~~
gyvastis
Thanks for the cool tool, didn't knew about it!

------
bougiefever
My grandmother died from this, and it is a horrible death. I really fear
becoming a victim to this disease. Anything that can help, even a little, is
so encouraging.

------
offsetr
Some people with a unique gift in sense of smell can do it even better than 6
years.

~~~
sierdolij
Sorry, what do you mean? Are there examples?

~~~
rincebrain
There was a specific case of a woman who realized, after her husband acquired
a peculiar smell and was 6 years later diagnosed with Parkinson's, then
everyone at a Parkinson's support group had that smell, that she could smell
Parkinson's in people well before any clinical tests.

She went to researchers who tested her with sweat from 6 diagnosed patients
and 6 controls - she identified the 6 diagnosed patients correctly, and one of
the controls who was later diagnosed with it but had not been yet.

[https://www.telegraph.co.uk/science/2017/12/18/woman-can-
sme...](https://www.telegraph.co.uk/science/2017/12/18/woman-can-smell-
parkinsons-disease-helps-scientists-develop/)

(Also, as a fascinating aside which probably isn't what the GP comment meant,
_loss_ of sense of smell is one of the earliest symptoms of Alzheimer's or
Parkinson's. Why? Good question.)

~~~
krzat
If a human can smell Parkinson, I wonder what a dog could smell.

~~~
rincebrain
There's all sorts of anecdotes of pets reacting to people being ill well
before the people put 2 and 2 together.

The primary problem, I think, is that you'd have difficulty convincing someone
to fund this research without a priori knowledge - e.g. if you don't already
know that there are (relatively) readily externally visible biochemistry
changes from a degenerative brain problem, why would you see if you can train
an animal to smell it?

It's similar to the question people posed after the PS3 signing key leak came
out - while it is the case that Sony was signing all PS3 (and PSP, if memory
serves) binaries with the same (all-zeroes?) random input, so they leaked
information sufficient to eventually retrieve the private key from enough
samples, why would you think to check if they did that without already
knowing?

(Or, more generally, the large domain of problems that is relatively-trivial
to verify a correct solution but infeasible to test all possible solutions in
order to find one.)

------
gesman
"People never lie so much as after a hunt, during a war or before an election"

\-- Otto von Bismarck

This quote need to be updated for modern times regarding performance of AI/ML
models.

------
mendelsd
Interesting that glucose levels are used, since they are significantly
affected by diet: [https://biology.stackexchange.com/questions/55853/what-is-
th...](https://biology.stackexchange.com/questions/55853/what-is-the-brains-
preferred-energy-source-glucose-or-ketones)

------
thegambit
*Machine Learning

~~~
TaupeRanger
*Computational Statistics (a better name for both, given current methods, since it avoids anthropomorphism and sci-fi implications in uninformed readership).

------
zwieback
How do they compare the AI performance to that of radiologists? The abstract
says that radiologists aren't as good at spotting subtle, diffuse changes but
what metric did they use to compare?

~~~
Eridrus
You get historical PET scans from years ago and label them with whether they
turned out to have Alzheimer's later in their life or not.

------
alexnewman
This is a great thing, but i wonder if it's actionable. What are the insurance
impacts?

------
crb002
23–26 mSv of radiation. If the Alzheimer's doesn't kill you the PET scan will
from a secondary cancer.

~~~
ceejayoz
[https://www.nrc.gov/reading-rm/doc-collections/fact-
sheets/b...](https://www.nrc.gov/reading-rm/doc-collections/fact-sheets/bio-
effects-radiation.html)

> The data show high doses of radiation may cause cancers. But there are no
> data to establish a firm link between cancer and doses below about 10,000
> mrem (100 mSv – 100 times the NRC limit).

