A Blood Test That Isolates A Specific Form Of RNA
I recently read an article about a potential blood test for Alzheimer's. It looks promising, but more studies need to be completed before it is validated and ready to be used as an early predictor.
You see this blood test is dependent on isolating a specific form of RNA that "leaks" out of the cell, where it is not supposed to be found. RNA is a messenger of DNA designed to facilitate the manufacture of specific proteins. Unfortunately, the researchers do not understand the mechanism that causes the type of RNA to be found outside the cell in Alzheimer's patients. But it does show promise as a potential diagnostic tool.
So here is my problem with this. From what I see here the individual in which this RNA is found in this specific blood test apparently is already in the process of dementia. Albeit perhaps the very early stages, but it is happening. So, is this test predictive of dementia/Alzheimer's? Or, is it more of a diagnostic tool once the process is already beginning? These are the questions that I would like to have us all ponder for a moment.
Let's take a step back and think about the entire concept of prevention and diagnostic tests. If we look at some of the tests that modern medicine considers preventative, see if you agree with me that maybe they should not be categorized as preventative at all.
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I will give you a couple of examples that I think will make my point. Some of you may have had the opportunity to experience the joy of going through the preparation for, and the fun experience of, a colonoscopy. I submit to you that even though this test is termed "preventative" by the medical community, I do not believe it should be termed preventative at all. What specifically is it preventing? If you have the test and it detects a cancerous lesion, did it prevent anything? No, it did not! You see, you already had the cancer at the time that the test was conducted. This test just detected the cancer. Now don't get me wrong, that is a good thing especially if it is early in the process, because it can be addressed and hopefully successfully removed so that you can live a longer, hopefully healthier life.
Another good example I can give you would be a mammogram. Any of you ladies who have been through this breast crushing experience can attest to the fact that it is not something that you look forward to when the time rolls around to have it done. But, just what does this test do. Does it prevent cancer? No, I can state emphatically that it does not prevent cancer or precancerous states. It may detect a cancerous growth, which may then be excised or treated using other forms of cancer treatment. But this test certainly does not prevent the formation, or growth of a cancerous lesion in the breast.
Here is another thing I would like all of you women to consider regarding this x-ray test. You see cancer although we pour billions of dollars into research is still in my opinion poorly understood. But there is one thing that we do know. The one thing we know without a doubt will cause cancer is radiation. Yet this is one of the diagnostic tools to detect cancer, and yes one of the treatments for this condition. That however is a topic for another time.
For those of you who are a little taken aback by these revelations I will concede that these tests, while not preventative, may certainly assist with "early detection" of conditions which will progress if not taken care of early in the process. So, let's consider calling these tests just what they are; "an early detection screening test". However, let's also concede that they are definitely not preventative.
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Nor is the test that I noted above for Alzheimer's. If the RNA has already begun to circulate in the blood stream it is an indication that the process of altered protein formation has already begun. Therefore this would also be considered an "early detection test".
So, what would be a preventative test for Alzheimer's? If you have a genetic test for the APOE-4 gene this would indicate that you have an increased likelihood of acquiring this condition. If you have two of these genes which have been supplied by both your mother and your father your potential has risen still further. Now, does this definitely mean you will develop Alzheimer's as you progress through life. Absolutely Not! But you definitely have an increased potential. So this test could be called a preventative test since you could and should take corrective action if you carry the APOE-4 gene.
What else would be a preventative test for Alzheimer's? The number one thing that will enhance your potential to acquire Alzheimer's is elevated blood sugar. This one variable will also increase your potential to have a stroke, heart attack, develop cancer, as well as Parkinson's Disease. So having your fasting blood glucose, and an A1-C test will also be a preventative test.
What else is a component for the onset of Alzheimer's? The nasty I-word of course. Inflammation! Yes, systemic inflammation is another component in the onset of Alzheimer's. So, what test could, and should you have done to detect inflammation. Well, in the Center I use several blood tests to determine a patient's "inflammatory load". If I were looking for just one diagnostic test to determine a patient's level of inflammation, I would choose a hs-CRP. A high sensitivity C-Reactive Protein test is a good test for a patient's overall inflammatory load.
Taking these tests in concert with a good case history, family history, and physical and cognitive test, along with genetic testing will give us a fairly good idea of a patient's potential to acquire Alzheimer's. These tests while I feel that they can be truly "preventative" providing the patient is willing to make lifestyle, and nutritional changes that are necessary. Also, these tests can be used for "early detection" as well to slow or halt the progression of the disorder.
My point in bringing you this information about this new research into a blood test for RNA and my subsequent dialogue is to drive home the point that a single test is truly of little value in diagnosing anything. I also want to make clear the difference between true "preventative testing", and "early detection testing."
I hope this makes sense to those of you who may have had to make a conceptual change regarding "preventative medicine." Let us please remember to call things what they really are. If something is designed to "detect" a condition which already exists in the body can we all begin to refer to the test as an "early detection test", and not a "preventative test".