Institute For The Future

20 Years from Now, You'll Have Alzheimer's

As part of our Ecosystems of Well-Being map last year, we argued that the increasing importance, as well as the increasingly confusing challenge, of anticipating how today's measures and metrics affect our future health states will be central to shaping health and well-being in the next decade. There are a couple of key challenges with anticipatory health--the first is that, for the most part, we can't anticipate with 100 percent accuracy, but instead, have to operate by understanding fuzzy probabilities of disease. The second problem is that even if we do know that something seems likely to occur, it's hard to know how to act.

Since we developed the map last year, there's been no shortage of efforts to improve anticipatory health efforts--ranging from prototypes aimed at the individual, like babybeat, which attempts to prevent sudden infant death by monitoring a baby for subtle changes and waking him up in the event of a warning, to companies like Kaggle, which, among other things, has created a data mining competition to identify which patients, among millions, are most likely to be re-admitted to a hospital.

But I think the tension inherent to anticipating is best exemplified by a recent breakthrough in understanding Alzheimer's: Namely, that researchers have identified biomarker changes that warn of Alzheimer's two decades in advance.

The first detectable signs of Alzheimer's disease occur as long as a quarter century before symptoms like memory loss become noticeable, according to a detailed chronology of molecular changes to the brain and spinal fluid of people who later developed the brain disease.

The research, published today in the New England Journal of Medicine, provides a timeline of the subtle changes that begin in victims' brains and, importantly, can be detected years ahead of time by MRI exams, blood analyses, or other tests.

The development of biomarkers that can track and predict the natural course of the disease is important for carrying out drug studies, in part because changes to these molecules could give early hints that a drug works. Treatments for Alzheimer's have all been unsuccessful so far—in part, researchers think, because people received drugs only after symptoms had become obvious and their brains were too damaged to recover.

As Technology Review notes, there's incredible research value here--armed with an understanding of the progression of Alzheimer's, researchers can figure out if different kinds of treatments work.

But the story is different if you suddenly find yourself diagnosed with these biomarkers. In other words, imagine your doctor saying, "Twenty years from now, you'll suffer from dementia. And there's nothing we can do."

In other words, in the next decade, anticipatory health will be driven by two key factors: Our scientific abilities to measure and better understand what today's metrics say about tomorrow's health, as well as our social structures for figuring out how to deal with messy, and at times, very difficult metrics.