Quote · The Peter Attia Drive
#399 ‒ The evolution of Alzheimer's disease and dementia care: how early detection, personalized treatment, new therapies, and a multimodal approach are changing the landscape | Gayatri Devi, M.D.
Where this was said
Blood-based biomarkers and asymptomatic screening
At 43:31 · chapter starts 40:15
Blood-based Alzheimer's biomarkers are improving rapidly, but Gayatri Devi cautions strongly against over-reliance on them. She opens with a case study: a patient diagnosed with Alzheimer's by a respected neurologist based solely on an abnormal Quest AD Detect test, who turned out to have a negative amyloid PET scan. The fundamental problem is that these blood tests are validated against amyloid PET scans — but amyloid is present in roughly 25% of asymptomatic 70-year-olds, 30%+ of 80-year-olds, and 44% of 90-year-olds without dementia [1] — Gayatri Devi "Blood-based Alzheimer's biomarkers are validated against amyloid PET scans — but 25–44% of people over 70 have amyloid in their brains with…" 42:13 . The Alzheimer's Association and the International Working Group hold opposing positions on this: the former diagnoses Alzheimer's based on amyloid alone; the latter requires amyloid plus tau plus clinical symptoms. Gayatri Devi sides closer to the International Working Group, reserving preclinical testing for high-risk individuals with strong family history and genetic risk factors, and warns that indiscriminate testing creates a large population of 'patients in waiting' who may never develop disease.
Blood-based Alzheimer's biomarkers are validated against amyloid PET scans — but 25–44% of people over 70 have amyloid in their brains without any dementia. Diagnosing Alzheimer's from a blood test alone risks creating a massive population of 'patients in waiting' who may never develop disease.
About 25% of community-dwelling people in their seventies have amyloid in their brains without any symptoms of dementia.
By age 90, approximately 44% of community-dwelling people have brain amyloid without dementia symptoms, undermining blood-test specificity.
