June 14, 2026 • 20 mins
Alzheimer’s doesn’t wait for a diagnosis to begin. The brain changes can start quietly for years, even a decade, while someone looks totally fine, passes cognitive tests, drives, works, and pays the same routine healthcare bills as their peers. That raises a tough question with massive public health stakes: if the disease is already active, when does it start costing Medicare real money?
We dig into a 2026 Journal of Prevention of Alzheimer’s Disease study that finally connects two missing halves of the puzzle: precise clinical trial data from cognitively normal adults with confirmed amyloid pathology, and real-world Medicare claims that record hospital stays, ER visits, home health care, and actual dollars spent. The surprising baseline finding is a true economic paradox: elevated amyloid alone does not meaningfully raise healthcare utilization or Medicare payments. The spending surge arrives later, when cognitive decline becomes disruptive enough to show up in claims and when frailty ramps up.
The most important takeaway is what drives the spike. It is not primarily dementia-specific treatment. Costs jump because slipping executive function makes everyday chronic disease management fall apart, turning “cheap” conditions like hypertension or diabetes into emergencies like falls, injuries, surgeries, and long recovery stays. We also talk about the detection gap between sensitive research tools and rushed primary care, why cognitive reserve may delay the tipping point for highly educated cohorts, and the provocative next frontier: if blood tests like p-tau217 make preclinical Alzheimer’s visible to everyone, does knowledge alone change behavior and spending before symptoms begin?
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This podcast is created by Ai for educational and entertainment purposes only and does not constitute professional medical or health advice. Please talk to your healthcare team for medical advice.
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SPEAKER_01 (00:00):
Usually um when we think about the financial impact
of a serious disease, we justassume there's a clear starting
gun, right?
SPEAKER_00 (00:06):
Right.
A a formal diagnosis.
SPEAKER_01 (00:07):
Aaron Ross Powell Exactly.
A doctor sits you down, handsover the diagnosis, and
immediately, bam, the medicalbills start piling up.
SPEAKER_00 (00:14):
Aaron Powell Yeah, that's the traditional
expectation.
SPEAKER_01 (00:16):
Aaron Powell It's just a simple linear
progression.
You know, you get sick, yourhealth care costs increase.
But um when you look at aneurodegenerative condition like
Alzheimer's disease, thattimeline completely shatters.
SPEAKER_00 (00:29):
Oh, it really does.
SPEAKER_01 (00:30):
The starting gun actually goes off years,
sometimes even a full decade,before anyone even hears the
starting pistol.
SPEAKER_00 (00:35):
Aaron Powell Right.
It's totally silent.
SPEAKER_01 (00:37):
So, okay, let's unpack this because today for
our deep dive, we're looking ata 2026 study from the Journal of
Prevention of Alzheimer'sDisease.
SPEAKER_00 (00:45):
Yeah.
And it's a really pivotal one.
SPEAKER_01 (00:47):
Aaron Powell It's titled Uh Increase in Healthcare
Utilization and Medicare Paymentwith Progression of Preclinical
Alzheimer's Disease.
SPEAKER_00 (00:54):
Yeah.
SPEAKER_01 (00:54):
And we are on a mission today to explore this
hidden timeline.
SPEAKER_00 (00:58):
Aaron Powell Which is so crucial for everyone to
understand.
This is really a first-of-itskind exploration into the
economic impact of thatpreclinical stage.
SPEAKER_01 (01:07):
Aaron Powell Because usually researchers are kind of
walled off, right?
SPEAKER_00 (01:10):
Trevor Burrus Yeah, exactly.
Historically, you have twototally distinct types of
information.
On one hand, you've got clinicaltrial data.
SPEAKER_01 (01:17):
The highly controlled stuff.
SPEAKER_00 (01:19):
Right.
It meticulously tracks biologyand objective cognitive scores
in this pristine laboratorysetting.
But on the other hand, you haveMedicare claims data.
Trevor Burrus, Jr.
SPEAKER_01 (01:29):
Which is, I mean, basically just a messy,
sprawling spreadsheet of actualhuman behavior.
SPEAKER_00 (01:33):
Trevor Burrus, Jr.: You know, ER visits, hospital
stays, the exact dollar amountsthe government is spending.
Right.
And this study is groundbreakingbecause they finally managed to
bridge that gap.
They securely linked preciseclinical trial data to
real-world Medicare claims tomap out exactly when this
biological disease startscosting the system money.
SPEAKER_01 (01:53):
Aaron Powell Which is wild.
So to really grasp the findingsfor you listening, we need to
completely separate thebiological definition of
Alzheimer's from the clinicaldiagnosis of dementia.
SPEAKER_00 (02:04):
Aaron Powell Yes.
That distinction is absolutelykey.
SPEAKER_01 (02:07):
Aaron Powell Because if you're keeping up with
neurodegenerative research, youknow the diagnostic criteria
have rapidly evolved.
We aren't just looking at memoryloss anymore.
SPEAKER_00 (02:16):
Not at all.
SPEAKER_01 (02:16):
The study focuses entirely on the Alzheimer's
continuum, specifically stagesone and two, right?
SPEAKER_00 (02:22):
Aaron Ross Powell Yeah, which represent the
preclinical stage.
SPEAKER_01 (02:24):
Aaron Powell So what does that actually look like for
a person?
SPEAKER_00 (02:26):
Aaron Ross Powell Well, in this preclinical phase,
the individual is cognitivelyunimpaired.
I mean, if you sat down and hada lengthy conversation with
them, or even gave them astandard cognitive test, they
would pass with flying colors.
SPEAKER_01 (02:39):
They're totally fine on the outside.
SPEAKER_00 (02:41):
Exactly.
They're driving, they'remanaging their finances, living
entirely independent lives.
But beneath the surface, thebiological machinery of the
brain is actively failing.
SPEAKER_01 (02:51):
That's the scary part.
SPEAKER_00 (02:52):
We are looking at the steady accumulation of
amyloid beta proteins.
They clump together to formthese sticky plaques between the
neurons, and it essentiallydisrupts cell-to-cell
communication.
SPEAKER_01 (03:03):
Aaron Powell And it isn't just the amyloid plaques
outside the cells, right?
Inside the neurons, the tauproteins are basically
collapsing.
SPEAKER_00 (03:09):
Aaron Powell Yeah, that is the secondary hallmark.
So tau proteins normally actlike think of them like railroad
ties.
SPEAKER_01 (03:15):
Aaron Powell Okay, railroad ties.
SPEAKER_00 (03:16):
Aaron Ross Powell Right.
They keep the internal transporttracks of brain cells perfectly
straight, so nutrients can flowfrom one end of the cell to the
other.
Oh wow.
But during this preclinicalstage, those tau proteins become
hyperphosphorylated.
They detach from the tracts, thetracts completely collapse, and
the tau proteins themselvestangle up into these chaotic
knots.
SPEAKER_01 (03:35):
So they're effectively starving the cell
from the inside out.
SPEAKER_00 (03:38):
Exactly.
That's exactly what's happening.
SPEAKER_01 (03:40):
And we also see the evidence of this internal
collapse leaking out of thebrain entirely, don't we?
The study highlights elevatedbiomarkers, um, like peta 217 in
the blood.
SPEAKER_00 (03:51):
Right, because as those tau tangles form and the
neurons degrade, fragments ofthese proteins are cleared out
of the brain into thecerebrospinal fluid.
SPEAKER_01 (04:01):
And then they eventually cross the blood-brain
barrier.
SPEAKER_00 (04:03):
Yep, they enter the bloodstream.
And that is how a simplearmprick at a lab can reveal
this profound structural damagehappening deep inside the brain.
SPEAKER_01 (04:12):
It's incredible that we can see that now.
But I mean, if we connect thisto the bigger picture, the sheer
scale of this invisible stage isstaggering.
SPEAKER_00 (04:21):
Oh, the numbers are huge.
SPEAKER_01 (04:23):
Based on current data, an estimated 6.7 million
Americans aged 55 to 64.
SPEAKER_00 (04:29):
And an astonishing 9.9 million aged 65 to 79.
SPEAKER_01 (04:33):
Right.
Almost 10 million people in thatolder bracket currently harbor
this amyloid buildup and theunderlying pathology without any
objective cognitive decline.
SPEAKER_00 (04:43):
It's really wild to think about.
That is millions of peoplewalking around with the active
biology of Alzheimer's totallyunaware because their cognitive
function hasn't dropped belowthat clinical threshold yet.
SPEAKER_01 (04:53):
Aaron Powell The best way I can describe this for
you is well, it's like havingtermites in your house.
SPEAKER_00 (04:58):
Oh, that's a perfect analogy.
SPEAKER_01 (04:59):
Right.
The biological foundation isactively being eaten away day by
day, month by month.
But you know, the walls haven'tstarted to sag yet, the roof
isn't leaking.
SPEAKER_00 (05:08):
You'd walk through the living room and think the
house looks absolutely perfect.
SPEAKER_01 (05:11):
Aaron Powell Exactly.
You wouldn't know the termiteswere there without a highly
specialized inspection, like uman amyloid PT scan or one of
those advanced biomarker bloodtests.
Right.
So the core question this studytackles is how do you track the
financial footprint of acompletely invisible disease?
How do we see when thosetermites actually start
affecting the house's value?
SPEAKER_00 (05:32):
And the researchers solved this by tracking two
incredibly rigorousobservational trials.
The primary group is the A4Medicare cohort.
SPEAKER_01 (05:40):
Which stands for anti-amyloid treatment in
asymptomatic Alzheimer's.
SPEAKER_00 (05:43):
Exactly.
They isolated 246 participantsaged 65 to 85.
Every single one of theseindividuals was cognitively
normal, but they had elevatedbrain amyloid definitively
confirmed by PEAT scans.
SPEAKER_01 (05:56):
Okay, so they definitely had the foundational
damage.
They had the termites.
SPEAKER_00 (05:59):
Precisely.
And then to create a baselinecomparison, they utilized the
Learn Medicare cohort.
SPEAKER_01 (06:04):
LEARN being longitudinal evaluation of
amyloid risk and nerdygeneration.
SPEAKER_00 (06:08):
You got it.
This served as the controlgroup.
It consisted of 121 participantswho were also completely
cognitively normal, butcrucially, their PE scans showed
no elevated amyloid.
SPEAKER_01 (06:23):
So their brains were completely clear of that primary
pathology.
SPEAKER_00 (06:26):
Right, no termites.
SPEAKER_01 (06:28):
Okay, but looking at this methodology, my mind
immediately jumps to afunctional question.
I mean, the administrative andprivacy hurdles to connect
tightly controlled anonymizedclinical trial data to someone's
actual government Medicarebilling history, that must be
astronomical.
SPEAKER_00 (06:45):
Oh, it's a massive, massive headache for
researchers.
SPEAKER_01 (06:47):
Aaron Powell So why go through all that trouble?
If you already have these twogroups under a microscope in a
clinical trial, why not justlook at the trial's internal
data?
Yeah.
You could see how they progressand estimate the cost from
there, couldn't you?
SPEAKER_00 (06:57):
Aaron Powell Well, you'd think so, but clinical
trials happen in a sterilevacuum.
They are phenomenal at trackingobjective biology.
They can tell you if a patient'sbrain volume shrank by a
millimeter or if they scored,you know, one point lower on a
specialized memory test.
SPEAKER_01 (07:11):
But they miss the real world.
SPEAKER_00 (07:12):
Exactly.
A clinical trial cannot tell youwhat happens when that same
patient goes home.
Medicare claims data tracks thechaotic reality of everyday
human life.
SPEAKER_01 (07:22):
Aaron Powell Which is where the actual money is
spent.
SPEAKER_00 (07:24):
Right.
A Medicare claim reveals if thatmicroscopic brain shrinkage
caused the patient to misjudge astep, fall down their front
stairs, end up in a traumacenter, and eventually need a
two-week stay in a skillednursing facility.
SPEAKER_01 (07:37):
Wow, yeah.
It bridges the gap betweenlaboratory science and everyday
life.
SPEAKER_00 (07:42):
It tells you exactly how many taxpayer and
out-of-pocket dollars were spentto treat the real-world
consequences of that biologicaldecline.
SPEAKER_01 (07:49):
So, okay, we have our two groups, the A4 group
with a hitting disease and thelearned group without it.
What did their lives and theirhealthcare bills look like
during the baseline periodbefore any clinical cognitive
decline actually kicked in?
SPEAKER_00 (08:02):
The baseline findings are fascinating because
they challenge a fundamentalassumption about disease
economics.
SPEAKER_01 (08:07):
Oh, so.
SPEAKER_00 (08:08):
Before the study officially tracked progression,
the A4 participants and thelearned participants had almost
identical overall healthcareutilization and Medicare
payments.
SPEAKER_01 (08:17):
Wait, wait, let me make sure I'm grasping the scale
of this.
Having active progressingAlzheimer's pathology in your
brain doesn't cost the system asingle extra dollar in the
beginning.
SPEAKER_00 (08:28):
The statistical analysis showed no significant
difference at all.
SPEAKER_01 (08:32):
That is wild.
SPEAKER_00 (08:33):
The A4 group's average total Medicare payment
was$449 per person per month.
The LEARN group averaged$394 permonth.
SPEAKER_01 (08:42):
Basically the same.
So what were they even going tothe doctor for?
SPEAKER_00 (08:45):
Both groups were just visiting primary care
doctors for standard age-relatedmaintenance.
Around 72 to 73% of participantsin both cohorts were managing
lipid disorders, like highcholesterol.
SPEAKER_01 (08:58):
Right, totally normal aging stuff.
SPEAKER_00 (09:00):
Yeah, and roughly half were being treated for
hypertension.
SPEAKER_01 (09:03):
Here's where it gets really interesting because this
highlights a massive economicparadox.
You have the physical biology ofa terminal, highly destructive
neurodegenerative diseaseoperating in your brain, yet
your medical footprint looksexactly like someone whose brain
is completely healthy.
SPEAKER_00 (09:18):
Yes.
What's fascinating here is howthe researchers validated this
lack of physical burden usingthe JN frailty index or the JFI.
SPEAKER_01 (09:26):
Oh, right, the claims-based measure.
SPEAKER_00 (09:29):
Exactly.
It's a brilliant tool thatcalculates physical frailty
entirely based on insuranceclaims.
Instead of a doctor physicallyexamining a patient's gate, the
JFI looks for specific billingcodes.
SPEAKER_01 (09:42):
Like orders for walkers or home health visits.
SPEAKER_00 (09:45):
Precisely.
And at baseline, the JFI scoreswere functionally identical
between the A4 and LERN cohorts.
The vast majority werecategorized as having low
frailty.
SPEAKER_01 (09:55):
So the pathology is actively destroying the internal
structure of the neurons, butthe person is still walking,
talking, and managing theircholesterol just fine.
SPEAKER_00 (10:03):
Yep.
The system is bearing zero extraweight during this preclinical
window.
SPEAKER_01 (10:08):
It proves there's this window of opportunity where
the biological presence of thedisease is there, but the
economic and clinical avalanchejust hasn't started falling down
the mountain yet.
SPEAKER_00 (10:18):
But you know, the biological bill always comes
due.
SPEAKER_01 (10:20):
Right, the dipping point.
SPEAKER_00 (10:21):
Exactly.
When the underlying pathologyfinally causes enough structural
damage to overwhelm the brain'scompensatory mechanisms, we
enter the on-study period.
Over time, the A4 group, theones with the amyloid, naturally
experienced faster cognitivedecline.
SPEAKER_01 (10:38):
And when that progression was officially
logged into their Medicareclaims, the costs didn't just
inch upward, they completelyexploded.
SPEAKER_00 (10:45):
Oh, it was a dramatic shift.
SPEAKER_01 (10:47):
Let's look at the specific financial triggers
here.
Because when an individual inthe A4 group received a Medicare
billing code for cognitiveimpairment, it triggered a 45%
increase in total Medicarespending compared to the
non-progressors.
SPEAKER_00 (11:01):
Which translates to an extra$140 per month.
SPEAKER_01 (11:05):
And if the decline progressed to a formal
Alzheimer's disease diagnosiscode, the burden jumped by 66%.
That's an extra$207 per month.
SPEAKER_00 (11:13):
And the physical frailty metric, that JFI score
we talked about, is where thenumbers become truly
catastrophic.
SPEAKER_01 (11:19):
Yeah, tell them about the JFI numbers.
SPEAKER_00 (11:20):
If a progressing patient's JN frailty index score
hit a six or higher meaning highfrailty, it caused a 103%
increase in healthcare payments.
SPEAKER_01 (11:29):
Over double.
SPEAKER_00 (11:29):
Right.
An extra$303 per month, workingout to over$3,600 a year in
additional Medicare spending fora single person.
SPEAKER_01 (11:38):
Aaron Powell But wait, I want to push back on
this a little bit or at leastclarify something.
Because when someone hears abouta 66% cost increase right after
an Alzheimer's diagnosis, theknee-jerk assumption is that the
money is going toward thedisease itself.
SPEAKER_00 (11:52):
Oh, sure.
You'd assume it's for newdementia medications.
SPEAKER_01 (11:54):
Aaron Powell Exactly.
Or billing the system for weeklyvisits to a highly specialized
neurologist are these extracosts just from that?
SPEAKER_00 (12:02):
Aaron Ross Powell That is the most common
misconception.
But the Medicare claims datathoroughly debunks it.
Really?
Yeah.
The massive spending spikes arenot driven by dementia-specific
treatments.
They are actually driven bysystemic ripple effects.
The data reveals sudden, sharpincreases in inpatient hospital
stays, outpatient emergency roomvisits, and extensive home
(12:22):
health utilization.
SPEAKER_01 (12:23):
Ah, okay.
So it's the collapse ofexecutive function causing a
cascade of other medical crises.
SPEAKER_00 (12:29):
Precisely.
Think about the baseline data.
You have a patient who hassuccessfully managed their
diabetes and hypertension fordecades.
SPEAKER_01 (12:36):
Right.
They know exactly when to taketheir insulin.
SPEAKER_00 (12:38):
But as preclinical Alzheimer's progresses, the
executive function required toexecute that complex daily
routine begins to slip.
The management of those existingcomorbidities just falls apart.
SPEAKER_01 (12:50):
So they forget a meal or take their blood
pressure medication twice.
SPEAKER_00 (12:54):
Aaron Ross Powell Exactly.
And that rapidly leads tosyncope or fainting.
They lose consciousness in thekitchen, they fall, they break a
hip.
Wow.
Suddenly, a patient who wascosting the system$400 a month
is in the back of an ambulancerequiring emergency surgery and
months of skilled nursing.
SPEAKER_01 (13:12):
So the brain disease itself isn't what runs up the
massive hospital bill.
It just makes it impossible forthe patient to safely pilot the
rest of their body.
SPEAKER_00 (13:20):
That's a great way to put it.
The pathology compromises theirability to navigate their own
health, turning cheap chronicconditions into incredibly
expensive medical emergencies.
SPEAKER_01 (13:30):
Which is terrifying.
But we also see this strangedisconnect in the study between
what a doctor sees in a trialand what shows up on a Medicare
claim, don't we?
SPEAKER_00 (13:39):
Yes.
And frankly, it's a veryconcerning discrepancy.
SPEAKER_01 (13:42):
Because in the clinical trial, researchers used
a measurement called theClinical Dementia Rating Scale
Global Score, the CDRGS.
SPEAKER_00 (13:50):
Right, which is a highly sensitive diagnostic tool
designed to catch the absoluteearliest, most subtle whispers
of cognitive decline.
SPEAKER_01 (13:58):
But here is the critical finding.5.
(14:32):
Very mild impairment.
SPEAKER_00 (14:34):
Right.
But real-world healthcare costsdon't increase until the
impairment is severe enough tocause a tangible disruption in
the patient's daily life.
SPEAKER_01 (14:41):
It's honestly just like a car's check engine light.
SPEAKER_00 (14:43):
Oh, I like that.
How so?
SPEAKER_01 (14:45):
Well, the clinical trial tests, the CDRGS, is like
taking your car to a mastermechanic who plugs a highly
advanced computer into thedashboard.
That computer finds amicroscopic fault in a tiny
sensor.
SPEAKER_00 (14:56):
But the car is still driving perfectly fine.
SPEAKER_01 (14:58):
Exactly.
You wouldn't even notice a dropin fuel efficiency.
But the mechanic's computerknows the part is failing.
That is the clinical trialcatching the earliest biological
decline.
But the Medicare claim, that'swhen the engine actually
overheats, the car is smoking onthe highway, and you have to
call a tow truck.
SPEAKER_00 (15:16):
That is spot on.
A primary care doctor in thereal world simply does not have
the resources to act like thatmaster mechanic.
A routine physical is what, 15minutes?
SPEAKER_01 (15:25):
Yeah, if you're lucky.
SPEAKER_00 (15:26):
The physician is checking blood pressure,
renewing a statin prescription.
In that 15-minute window, asubtle cognitive decline, a 0.5
on the CDRGS is completelyinvisible to them.
So they have no reason to inputa new diagnostic billing code.
SPEAKER_01 (15:41):
Aaron Powell, which means there is this hidden gap.
A period where the decline istechnically measurable in a lab,
but it hasn't yet caused enoughfunctional damage to break your
life in the real world.
SPEAKER_00 (15:51):
And that gap is the ultimate focus of preventative
medicine.
It's the final window forintervention before the
financial avalanche istriggered.
SPEAKER_01 (16:00):
Aaron Powell So bringing all this data together,
what are the implications forthe listener?
I mean, obviously the studyconcludes that delaying the
progression of Alzheimer's inthis preclinical stage could
save massive amounts of moneyfor Medicare.
Trevor Burrus, Jr.
SPEAKER_00 (16:13):
Huge amounts.
But looking at the study'sdesign, there is a massive
demographic caveat here.
SPEAKER_01 (16:19):
Aaron Ross Powell Right, we have to mention this.
SPEAKER_00 (16:20):
Trevor Burrus The researchers were very
transparent about it.
The participants in both the A4and learn groups were
predominantly white, highlyproactive about volunteering for
trials, and incredibly welleducated.
SPEAKER_01 (16:32):
Aaron Powell The average participant had 17 years
of education.
That is essentially a master'sdegree.
SPEAKER_00 (16:37):
Aaron Powell Exactly.
And in neurobiology, 17 years ofrigorous education provides a
massive amount of what we callcognitive reserve.
SPEAKER_01 (16:45):
Aaron Powell Which is the brain's ability to
improvise, right, to findalternate ways of getting a job
done.
SPEAKER_00 (16:50):
Yes.
A highly educated brain buildscomplex, redundant neural
networks over a lifetime.
So when the Alzheimer'spathology begins destroying
specific pathways, a brain withhigh cognitive reserve can
essentially build detours aroundthe microscopic damage.
SPEAKER_01 (17:06):
They can continue to function normally and manage
their medications much longerthan someone with less cognitive
reserve.
SPEAKER_00 (17:12):
Exactly.
They delay the tipping point.
The structural damage ishappening, but their brain's
internal redundancy preventsthem from crashing into the
healthcare system as quickly.
SPEAKER_01 (17:22):
Plus, that specific demographic probably has better
access to private resources tomanage early slip-ups, right?
SPEAKER_00 (17:29):
Oh, absolutely.
Which implies a really harshreality for the broader, less
resourced general population.
For individuals without 17 yearsof education, the threshold for
clinical progression might becrossed much faster.
SPEAKER_01 (17:42):
The detours fail sooner.
SPEAKER_00 (17:44):
Right.
So the catastrophic cost spikeswe discussed could be even more
severe in the generalpopulation, and they'd likely
happen much earlier in thedisease timeline.
SPEAKER_01 (17:52):
So what does this all mean for you?
It means the fight againstAlzheimer's isn't just about
managing dementia anymore.
SPEAKER_00 (17:59):
It can't be.
The public health policy focushas been on managing the fallout
building memory care facilities,hiring home health aides.
SPEAKER_01 (18:07):
But this data proves the war is won by intercepting
the disease while it's stillcompletely invisible.
SPEAKER_00 (18:14):
The ultimate goal is applying effective disease
modifying therapies during thepreclinical stage.
If we can halt that amyloidbuildup while the patient is
still cognitively normal, wearen't just saving memories.
SPEAKER_01 (18:27):
We are preventing that devastating transition from
a silent biological state to acatastrophic economic burden.
SPEAKER_00 (18:33):
Exactly.
Catching the failing sensorbefore the engine catches fire.
SPEAKER_01 (18:36):
To quickly summarize our deep dive today, Alzheimer's
begins in the brain long beforeit begins in our daily lives.
And the true financialdevastation only erupts when
clinical symptoms finallydisrupt a person's ability to
manage their overall health.
SPEAKER_00 (18:50):
Well said.
SPEAKER_01 (18:51):
But I want to leave you with a final, slightly
provocative thought to mullover.
The study proves that simplyhaving the biology of
preclinical Alzheimer's doesn'tincrease your healthcare costs,
as long as you remainsymptom-free.
SPEAKER_00 (19:02):
Right.
Because you have no idea it'shappening.
The lack of awareness preservesthe baseline.
SPEAKER_01 (19:07):
Right.
But medical diagnostics areadvancing so fast.
Highly sensitive blood tests,like for that PTOD 217 we
mentioned, are moving towardcommercial availability.
Soon, screening for Alzheimer'smight just be a standard box
your doctor checks at aphysical.
Which is an amazing medicaladvancement, but what happens
when the invisible forcefullybecomes visible?
(19:28):
Will simply knowing you havepreclinical Alzheimer's change
your healthcare utilization?
SPEAKER_00 (19:33):
Even with zero clinical symptoms.
SPEAKER_01 (19:35):
Exactly.
If an armprick tells you themachinery of Alzheimer's is
actively grinding away in yourbrain, but you feel completely
fine, how does human psychologyalter the spreadsheet?
Will the sheer anxiety, the pushfor preemptive neurological
care, the extra testing drive upcosts immediately?
SPEAKER_00 (19:51):
It's a huge question.
Will it fundamentally destroythe calm before the storm
period?
SPEAKER_01 (19:57):
Will the financial burden shift years earlier just
because we peered behind thecurtain too soon?
It is a complex economic andhuman dilemma that we are all
going to have to grapple withvery shortly.
Thank you for joining us on thisdeep dive into the hidden
timeline of Alzheimer's.
Keep questioning the worldaround you, and we'll catch you
on the next one.
Usually um when we think about the financial impact
of a serious disease, we justassume there's a clear starting
gun, right?
SPEAKER_00 (00:06):
Right.
A a formal diagnosis.
SPEAKER_01 (00:07):
Aaron Ross Powell Exactly.
A doctor sits you down, handsover the diagnosis, and
immediately, bam, the medicalbills start piling up.
SPEAKER_00 (00:14):
Aaron Powell Yeah, that's the traditional
expectation.
SPEAKER_01 (00:16):
Aaron Powell It's just a simple linear
progression.
You know, you get sick, yourhealth care costs increase.
But um when you look at aneurodegenerative condition like
Alzheimer's disease, thattimeline completely shatters.
SPEAKER_00 (00:29):
Oh, it really does.
SPEAKER_01 (00:30):
The starting gun actually goes off years,
sometimes even a full decade,before anyone even hears the
starting pistol.
SPEAKER_00 (00:35):
Aaron Powell Right.
It's totally silent.
SPEAKER_01 (00:37):
So, okay, let's unpack this because today for
our deep dive, we're looking ata 2026 study from the Journal of
Prevention of Alzheimer'sDisease.
SPEAKER_00 (00:45):
Yeah.
And it's a really pivotal one.
SPEAKER_01 (00:47):
Aaron Powell It's titled Uh Increase in Healthcare
Utilization and Medicare Paymentwith Progression of Preclinical
Alzheimer's Disease.
SPEAKER_00 (00:54):
Yeah.
SPEAKER_01 (00:54):
And we are on a mission today to explore this
hidden timeline.
SPEAKER_00 (00:58):
Aaron Powell Which is so crucial for everyone to
understand.
This is really a first-of-itskind exploration into the
economic impact of thatpreclinical stage.
SPEAKER_01 (01:07):
Aaron Powell Because usually researchers are kind of
walled off, right?
SPEAKER_00 (01:10):
Trevor Burrus Yeah, exactly.
Historically, you have twototally distinct types of
information.
On one hand, you've got clinicaltrial data.
SPEAKER_01 (01:17):
The highly controlled stuff.
SPEAKER_00 (01:19):
Right.
It meticulously tracks biologyand objective cognitive scores
in this pristine laboratorysetting.
But on the other hand, you haveMedicare claims data.
Trevor Burrus, Jr.
SPEAKER_01 (01:29):
Which is, I mean, basically just a messy,
sprawling spreadsheet of actualhuman behavior.
SPEAKER_00 (01:33):
Trevor Burrus, Jr.: You know, ER visits, hospital
stays, the exact dollar amountsthe government is spending.
Right.
And this study is groundbreakingbecause they finally managed to
bridge that gap.
They securely linked preciseclinical trial data to
real-world Medicare claims tomap out exactly when this
biological disease startscosting the system money.
SPEAKER_01 (01:53):
Aaron Powell Which is wild.
So to really grasp the findingsfor you listening, we need to
completely separate thebiological definition of
Alzheimer's from the clinicaldiagnosis of dementia.
SPEAKER_00 (02:04):
Aaron Powell Yes.
That distinction is absolutelykey.
SPEAKER_01 (02:07):
Aaron Powell Because if you're keeping up with
neurodegenerative research, youknow the diagnostic criteria
have rapidly evolved.
We aren't just looking at memoryloss anymore.
SPEAKER_00 (02:16):
Not at all.
SPEAKER_01 (02:16):
The study focuses entirely on the Alzheimer's
continuum, specifically stagesone and two, right?
SPEAKER_00 (02:22):
Aaron Ross Powell Yeah, which represent the
preclinical stage.
SPEAKER_01 (02:24):
Aaron Powell So what does that actually look like for
a person?
SPEAKER_00 (02:26):
Aaron Ross Powell Well, in this preclinical phase,
the individual is cognitivelyunimpaired.
I mean, if you sat down and hada lengthy conversation with
them, or even gave them astandard cognitive test, they
would pass with flying colors.
SPEAKER_01 (02:39):
They're totally fine on the outside.
SPEAKER_00 (02:41):
Exactly.
They're driving, they'remanaging their finances, living
entirely independent lives.
But beneath the surface, thebiological machinery of the
brain is actively failing.
SPEAKER_01 (02:51):
That's the scary part.
SPEAKER_00 (02:52):
We are looking at the steady accumulation of
amyloid beta proteins.
They clump together to formthese sticky plaques between the
neurons, and it essentiallydisrupts cell-to-cell
communication.
SPEAKER_01 (03:03):
Aaron Powell And it isn't just the amyloid plaques
outside the cells, right?
Inside the neurons, the tauproteins are basically
collapsing.
SPEAKER_00 (03:09):
Aaron Powell Yeah, that is the secondary hallmark.
So tau proteins normally actlike think of them like railroad
ties.
SPEAKER_01 (03:15):
Aaron Powell Okay, railroad ties.
SPEAKER_00 (03:16):
Aaron Ross Powell Right.
They keep the internal transporttracks of brain cells perfectly
straight, so nutrients can flowfrom one end of the cell to the
other.
Oh wow.
But during this preclinicalstage, those tau proteins become
hyperphosphorylated.
They detach from the tracts, thetracts completely collapse, and
the tau proteins themselvestangle up into these chaotic
knots.
SPEAKER_01 (03:35):
So they're effectively starving the cell
from the inside out.
SPEAKER_00 (03:38):
Exactly.
That's exactly what's happening.
SPEAKER_01 (03:40):
And we also see the evidence of this internal
collapse leaking out of thebrain entirely, don't we?
The study highlights elevatedbiomarkers, um, like peta 217 in
the blood.
SPEAKER_00 (03:51):
Right, because as those tau tangles form and the
neurons degrade, fragments ofthese proteins are cleared out
of the brain into thecerebrospinal fluid.
SPEAKER_01 (04:01):
And then they eventually cross the blood-brain
barrier.
SPEAKER_00 (04:03):
Yep, they enter the bloodstream.
And that is how a simplearmprick at a lab can reveal
this profound structural damagehappening deep inside the brain.
SPEAKER_01 (04:12):
It's incredible that we can see that now.
But I mean, if we connect thisto the bigger picture, the sheer
scale of this invisible stage isstaggering.
SPEAKER_00 (04:21):
Oh, the numbers are huge.
SPEAKER_01 (04:23):
Based on current data, an estimated 6.7 million
Americans aged 55 to 64.
SPEAKER_00 (04:29):
And an astonishing 9.9 million aged 65 to 79.
SPEAKER_01 (04:33):
Right.
Almost 10 million people in thatolder bracket currently harbor
this amyloid buildup and theunderlying pathology without any
objective cognitive decline.
SPEAKER_00 (04:43):
It's really wild to think about.
That is millions of peoplewalking around with the active
biology of Alzheimer's totallyunaware because their cognitive
function hasn't dropped belowthat clinical threshold yet.
SPEAKER_01 (04:53):
Aaron Powell The best way I can describe this for
you is well, it's like havingtermites in your house.
SPEAKER_00 (04:58):
Oh, that's a perfect analogy.
SPEAKER_01 (04:59):
Right.
The biological foundation isactively being eaten away day by
day, month by month.
But you know, the walls haven'tstarted to sag yet, the roof
isn't leaking.
SPEAKER_00 (05:08):
You'd walk through the living room and think the
house looks absolutely perfect.
SPEAKER_01 (05:11):
Aaron Powell Exactly.
You wouldn't know the termiteswere there without a highly
specialized inspection, like uman amyloid PT scan or one of
those advanced biomarker bloodtests.
Right.
So the core question this studytackles is how do you track the
financial footprint of acompletely invisible disease?
How do we see when thosetermites actually start
affecting the house's value?
SPEAKER_00 (05:32):
And the researchers solved this by tracking two
incredibly rigorousobservational trials.
The primary group is the A4Medicare cohort.
SPEAKER_01 (05:40):
Which stands for anti-amyloid treatment in
asymptomatic Alzheimer's.
SPEAKER_00 (05:43):
Exactly.
They isolated 246 participantsaged 65 to 85.
Every single one of theseindividuals was cognitively
normal, but they had elevatedbrain amyloid definitively
confirmed by PEAT scans.
SPEAKER_01 (05:56):
Okay, so they definitely had the foundational
damage.
They had the termites.
SPEAKER_00 (05:59):
Precisely.
And then to create a baselinecomparison, they utilized the
Learn Medicare cohort.
SPEAKER_01 (06:04):
LEARN being longitudinal evaluation of
amyloid risk and nerdygeneration.
SPEAKER_00 (06:08):
You got it.
This served as the controlgroup.
It consisted of 121 participantswho were also completely
cognitively normal, butcrucially, their PE scans showed
no elevated amyloid.
SPEAKER_01 (06:23):
So their brains were completely clear of that primary
pathology.
SPEAKER_00 (06:26):
Right, no termites.
SPEAKER_01 (06:28):
Okay, but looking at this methodology, my mind
immediately jumps to afunctional question.
I mean, the administrative andprivacy hurdles to connect
tightly controlled anonymizedclinical trial data to someone's
actual government Medicarebilling history, that must be
astronomical.
SPEAKER_00 (06:45):
Oh, it's a massive, massive headache for
researchers.
SPEAKER_01 (06:47):
Aaron Powell So why go through all that trouble?
If you already have these twogroups under a microscope in a
clinical trial, why not justlook at the trial's internal
data?
Yeah.
You could see how they progressand estimate the cost from
there, couldn't you?
SPEAKER_00 (06:57):
Aaron Powell Well, you'd think so, but clinical
trials happen in a sterilevacuum.
They are phenomenal at trackingobjective biology.
They can tell you if a patient'sbrain volume shrank by a
millimeter or if they scored,you know, one point lower on a
specialized memory test.
SPEAKER_01 (07:11):
But they miss the real world.
SPEAKER_00 (07:12):
Exactly.
A clinical trial cannot tell youwhat happens when that same
patient goes home.
Medicare claims data tracks thechaotic reality of everyday
human life.
SPEAKER_01 (07:22):
Aaron Powell Which is where the actual money is
spent.
SPEAKER_00 (07:24):
Right.
A Medicare claim reveals if thatmicroscopic brain shrinkage
caused the patient to misjudge astep, fall down their front
stairs, end up in a traumacenter, and eventually need a
two-week stay in a skillednursing facility.
SPEAKER_01 (07:37):
Wow, yeah.
It bridges the gap betweenlaboratory science and everyday
life.
SPEAKER_00 (07:42):
It tells you exactly how many taxpayer and
out-of-pocket dollars were spentto treat the real-world
consequences of that biologicaldecline.
SPEAKER_01 (07:49):
So, okay, we have our two groups, the A4 group
with a hitting disease and thelearned group without it.
What did their lives and theirhealthcare bills look like
during the baseline periodbefore any clinical cognitive
decline actually kicked in?
SPEAKER_00 (08:02):
The baseline findings are fascinating because
they challenge a fundamentalassumption about disease
economics.
SPEAKER_01 (08:07):
Oh, so.
SPEAKER_00 (08:08):
Before the study officially tracked progression,
the A4 participants and thelearned participants had almost
identical overall healthcareutilization and Medicare
payments.
SPEAKER_01 (08:17):
Wait, wait, let me make sure I'm grasping the scale
of this.
Having active progressingAlzheimer's pathology in your
brain doesn't cost the system asingle extra dollar in the
beginning.
SPEAKER_00 (08:28):
The statistical analysis showed no significant
difference at all.
SPEAKER_01 (08:32):
That is wild.
SPEAKER_00 (08:33):
The A4 group's average total Medicare payment
was$449 per person per month.
The LEARN group averaged$394 permonth.
SPEAKER_01 (08:42):
Basically the same.
So what were they even going tothe doctor for?
SPEAKER_00 (08:45):
Both groups were just visiting primary care
doctors for standard age-relatedmaintenance.
Around 72 to 73% of participantsin both cohorts were managing
lipid disorders, like highcholesterol.
SPEAKER_01 (08:58):
Right, totally normal aging stuff.
SPEAKER_00 (09:00):
Yeah, and roughly half were being treated for
hypertension.
SPEAKER_01 (09:03):
Here's where it gets really interesting because this
highlights a massive economicparadox.
You have the physical biology ofa terminal, highly destructive
neurodegenerative diseaseoperating in your brain, yet
your medical footprint looksexactly like someone whose brain
is completely healthy.
SPEAKER_00 (09:18):
Yes.
What's fascinating here is howthe researchers validated this
lack of physical burden usingthe JN frailty index or the JFI.
SPEAKER_01 (09:26):
Oh, right, the claims-based measure.
SPEAKER_00 (09:29):
Exactly.
It's a brilliant tool thatcalculates physical frailty
entirely based on insuranceclaims.
Instead of a doctor physicallyexamining a patient's gate, the
JFI looks for specific billingcodes.
SPEAKER_01 (09:42):
Like orders for walkers or home health visits.
SPEAKER_00 (09:45):
Precisely.
And at baseline, the JFI scoreswere functionally identical
between the A4 and LERN cohorts.
The vast majority werecategorized as having low
frailty.
SPEAKER_01 (09:55):
So the pathology is actively destroying the internal
structure of the neurons, butthe person is still walking,
talking, and managing theircholesterol just fine.
SPEAKER_00 (10:03):
Yep.
The system is bearing zero extraweight during this preclinical
window.
SPEAKER_01 (10:08):
It proves there's this window of opportunity where
the biological presence of thedisease is there, but the
economic and clinical avalanchejust hasn't started falling down
the mountain yet.
SPEAKER_00 (10:18):
But you know, the biological bill always comes
due.
SPEAKER_01 (10:20):
Right, the dipping point.
SPEAKER_00 (10:21):
Exactly.
When the underlying pathologyfinally causes enough structural
damage to overwhelm the brain'scompensatory mechanisms, we
enter the on-study period.
Over time, the A4 group, theones with the amyloid, naturally
experienced faster cognitivedecline.
SPEAKER_01 (10:38):
And when that progression was officially
logged into their Medicareclaims, the costs didn't just
inch upward, they completelyexploded.
SPEAKER_00 (10:45):
Oh, it was a dramatic shift.
SPEAKER_01 (10:47):
Let's look at the specific financial triggers
here.
Because when an individual inthe A4 group received a Medicare
billing code for cognitiveimpairment, it triggered a 45%
increase in total Medicarespending compared to the
non-progressors.
SPEAKER_00 (11:01):
Which translates to an extra$140 per month.
SPEAKER_01 (11:05):
And if the decline progressed to a formal
Alzheimer's disease diagnosiscode, the burden jumped by 66%.
That's an extra$207 per month.
SPEAKER_00 (11:13):
And the physical frailty metric, that JFI score
we talked about, is where thenumbers become truly
catastrophic.
SPEAKER_01 (11:19):
Yeah, tell them about the JFI numbers.
SPEAKER_00 (11:20):
If a progressing patient's JN frailty index score
hit a six or higher meaning highfrailty, it caused a 103%
increase in healthcare payments.
SPEAKER_01 (11:29):
Over double.
SPEAKER_00 (11:29):
Right.
An extra$303 per month, workingout to over$3,600 a year in
additional Medicare spending fora single person.
SPEAKER_01 (11:38):
Aaron Powell But wait, I want to push back on
this a little bit or at leastclarify something.
Because when someone hears abouta 66% cost increase right after
an Alzheimer's diagnosis, theknee-jerk assumption is that the
money is going toward thedisease itself.
SPEAKER_00 (11:52):
Oh, sure.
You'd assume it's for newdementia medications.
SPEAKER_01 (11:54):
Aaron Powell Exactly.
Or billing the system for weeklyvisits to a highly specialized
neurologist are these extracosts just from that?
SPEAKER_00 (12:02):
Aaron Ross Powell That is the most common
misconception.
But the Medicare claims datathoroughly debunks it.
Really?
Yeah.
The massive spending spikes arenot driven by dementia-specific
treatments.
They are actually driven bysystemic ripple effects.
The data reveals sudden, sharpincreases in inpatient hospital
stays, outpatient emergency roomvisits, and extensive home
(12:22):
health utilization.
SPEAKER_01 (12:23):
Ah, okay.
So it's the collapse ofexecutive function causing a
cascade of other medical crises.
SPEAKER_00 (12:29):
Precisely.
Think about the baseline data.
You have a patient who hassuccessfully managed their
diabetes and hypertension fordecades.
SPEAKER_01 (12:36):
Right.
They know exactly when to taketheir insulin.
SPEAKER_00 (12:38):
But as preclinical Alzheimer's progresses, the
executive function required toexecute that complex daily
routine begins to slip.
The management of those existingcomorbidities just falls apart.
SPEAKER_01 (12:50):
So they forget a meal or take their blood
pressure medication twice.
SPEAKER_00 (12:54):
Aaron Ross Powell Exactly.
And that rapidly leads tosyncope or fainting.
They lose consciousness in thekitchen, they fall, they break a
hip.
Wow.
Suddenly, a patient who wascosting the system$400 a month
is in the back of an ambulancerequiring emergency surgery and
months of skilled nursing.
SPEAKER_01 (13:12):
So the brain disease itself isn't what runs up the
massive hospital bill.
It just makes it impossible forthe patient to safely pilot the
rest of their body.
SPEAKER_00 (13:20):
That's a great way to put it.
The pathology compromises theirability to navigate their own
health, turning cheap chronicconditions into incredibly
expensive medical emergencies.
SPEAKER_01 (13:30):
Which is terrifying.
But we also see this strangedisconnect in the study between
what a doctor sees in a trialand what shows up on a Medicare
claim, don't we?
SPEAKER_00 (13:39):
Yes.
And frankly, it's a veryconcerning discrepancy.
SPEAKER_01 (13:42):
Because in the clinical trial, researchers used
a measurement called theClinical Dementia Rating Scale
Global Score, the CDRGS.
SPEAKER_00 (13:50):
Right, which is a highly sensitive diagnostic tool
designed to catch the absoluteearliest, most subtle whispers
of cognitive decline.
SPEAKER_01 (13:58):
But here is the critical finding.5.
(14:32):
Very mild impairment.
SPEAKER_00 (14:34):
Right.
But real-world healthcare costsdon't increase until the
impairment is severe enough tocause a tangible disruption in
the patient's daily life.
SPEAKER_01 (14:41):
It's honestly just like a car's check engine light.
SPEAKER_00 (14:43):
Oh, I like that.
How so?
SPEAKER_01 (14:45):
Well, the clinical trial tests, the CDRGS, is like
taking your car to a mastermechanic who plugs a highly
advanced computer into thedashboard.
That computer finds amicroscopic fault in a tiny
sensor.
SPEAKER_00 (14:56):
But the car is still driving perfectly fine.
SPEAKER_01 (14:58):
Exactly.
You wouldn't even notice a dropin fuel efficiency.
But the mechanic's computerknows the part is failing.
That is the clinical trialcatching the earliest biological
decline.
But the Medicare claim, that'swhen the engine actually
overheats, the car is smoking onthe highway, and you have to
call a tow truck.
SPEAKER_00 (15:16):
That is spot on.
A primary care doctor in thereal world simply does not have
the resources to act like thatmaster mechanic.
A routine physical is what, 15minutes?
SPEAKER_01 (15:25):
Yeah, if you're lucky.
SPEAKER_00 (15:26):
The physician is checking blood pressure,
renewing a statin prescription.
In that 15-minute window, asubtle cognitive decline, a 0.5
on the CDRGS is completelyinvisible to them.
So they have no reason to inputa new diagnostic billing code.
SPEAKER_01 (15:41):
Aaron Powell, which means there is this hidden gap.
A period where the decline istechnically measurable in a lab,
but it hasn't yet caused enoughfunctional damage to break your
life in the real world.
SPEAKER_00 (15:51):
And that gap is the ultimate focus of preventative
medicine.
It's the final window forintervention before the
financial avalanche istriggered.
SPEAKER_01 (16:00):
Aaron Powell So bringing all this data together,
what are the implications forthe listener?
I mean, obviously the studyconcludes that delaying the
progression of Alzheimer's inthis preclinical stage could
save massive amounts of moneyfor Medicare.
Trevor Burrus, Jr.
SPEAKER_00 (16:13):
Huge amounts.
But looking at the study'sdesign, there is a massive
demographic caveat here.
SPEAKER_01 (16:19):
Aaron Ross Powell Right, we have to mention this.
SPEAKER_00 (16:20):
Trevor Burrus The researchers were very
transparent about it.
The participants in both the A4and learn groups were
predominantly white, highlyproactive about volunteering for
trials, and incredibly welleducated.
SPEAKER_01 (16:32):
Aaron Powell The average participant had 17 years
of education.
That is essentially a master'sdegree.
SPEAKER_00 (16:37):
Aaron Powell Exactly.
And in neurobiology, 17 years ofrigorous education provides a
massive amount of what we callcognitive reserve.
SPEAKER_01 (16:45):
Aaron Powell Which is the brain's ability to
improvise, right, to findalternate ways of getting a job
done.
SPEAKER_00 (16:50):
Yes.
A highly educated brain buildscomplex, redundant neural
networks over a lifetime.
So when the Alzheimer'spathology begins destroying
specific pathways, a brain withhigh cognitive reserve can
essentially build detours aroundthe microscopic damage.
SPEAKER_01 (17:06):
They can continue to function normally and manage
their medications much longerthan someone with less cognitive
reserve.
SPEAKER_00 (17:12):
Exactly.
They delay the tipping point.
The structural damage ishappening, but their brain's
internal redundancy preventsthem from crashing into the
healthcare system as quickly.
SPEAKER_01 (17:22):
Plus, that specific demographic probably has better
access to private resources tomanage early slip-ups, right?
SPEAKER_00 (17:29):
Oh, absolutely.
Which implies a really harshreality for the broader, less
resourced general population.
For individuals without 17 yearsof education, the threshold for
clinical progression might becrossed much faster.
SPEAKER_01 (17:42):
The detours fail sooner.
SPEAKER_00 (17:44):
Right.
So the catastrophic cost spikeswe discussed could be even more
severe in the generalpopulation, and they'd likely
happen much earlier in thedisease timeline.
SPEAKER_01 (17:52):
So what does this all mean for you?
It means the fight againstAlzheimer's isn't just about
managing dementia anymore.
SPEAKER_00 (17:59):
It can't be.
The public health policy focushas been on managing the fallout
building memory care facilities,hiring home health aides.
SPEAKER_01 (18:07):
But this data proves the war is won by intercepting
the disease while it's stillcompletely invisible.
SPEAKER_00 (18:14):
The ultimate goal is applying effective disease
modifying therapies during thepreclinical stage.
If we can halt that amyloidbuildup while the patient is
still cognitively normal, wearen't just saving memories.
SPEAKER_01 (18:27):
We are preventing that devastating transition from
a silent biological state to acatastrophic economic burden.
SPEAKER_00 (18:33):
Exactly.
Catching the failing sensorbefore the engine catches fire.
SPEAKER_01 (18:36):
To quickly summarize our deep dive today, Alzheimer's
begins in the brain long beforeit begins in our daily lives.
And the true financialdevastation only erupts when
clinical symptoms finallydisrupt a person's ability to
manage their overall health.
SPEAKER_00 (18:50):
Well said.
SPEAKER_01 (18:51):
But I want to leave you with a final, slightly
provocative thought to mullover.
The study proves that simplyhaving the biology of
preclinical Alzheimer's doesn'tincrease your healthcare costs,
as long as you remainsymptom-free.
SPEAKER_00 (19:02):
Right.
Because you have no idea it'shappening.
The lack of awareness preservesthe baseline.
SPEAKER_01 (19:07):
Right.
But medical diagnostics areadvancing so fast.
Highly sensitive blood tests,like for that PTOD 217 we
mentioned, are moving towardcommercial availability.
Soon, screening for Alzheimer'smight just be a standard box
your doctor checks at aphysical.
Which is an amazing medicaladvancement, but what happens
when the invisible forcefullybecomes visible?
(19:28):
Will simply knowing you havepreclinical Alzheimer's change
your healthcare utilization?
SPEAKER_00 (19:33):
Even with zero clinical symptoms.
SPEAKER_01 (19:35):
Exactly.
If an armprick tells you themachinery of Alzheimer's is
actively grinding away in yourbrain, but you feel completely
fine, how does human psychologyalter the spreadsheet?
Will the sheer anxiety, the pushfor preemptive neurological
care, the extra testing drive upcosts immediately?
SPEAKER_00 (19:51):
It's a huge question.
Will it fundamentally destroythe calm before the storm
period?
SPEAKER_01 (19:57):
Will the financial burden shift years earlier just
because we peered behind thecurtain too soon?
It is a complex economic andhuman dilemma that we are all
going to have to grapple withvery shortly.
Thank you for joining us on thisdeep dive into the hidden
timeline of Alzheimer's.
Keep questioning the worldaround you, and we'll catch you
on the next one.
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