Alberto J Espay
@AlbertoEspay
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#Neurology professor @uofcincy . Advocate of precision medicine in #Parkinsons & #Alzheimers . Cofounder of Regain to correct proteinopenia. Author #BrainFables .
Cincinnati, OH
Joined October 2019
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The Synucleinopenia Hypothesis: Lewy pathology is made of what once were normal α-synuclein monomers. Entrapped, they can no longer function. Losing enough α-synuclein brings out
#Parkinsons
. Lewy pathology alone doesn't.
@ajlees
@ParkinsonismD
6
23
115
Are neurologists losing their clinical skills? This was the question posed by Andrew Lees (
@ajlees
) at the
#Neuro2022
Congress in Fortaleza. The risks of relinquishing the value of history and examination to surveys and tests are real. Solutions are within reach.
25
72
293
Lecanemab (Leqembi) --A Visual Abstract of the data for the Consumer.
#Alzheimers
#Leqembi
@alzassociation
@alzforum
15
100
258
I learned in medical school that clinical trials are the best test of a hypothesis. In this week’s issue of
@NEJM
, two anti-synuclein trials tested the hypothesis that α-synuclein is toxic and both were negative.
What keeps us from falsifying the hypothesis? (1/8)
19
75
253
Concise Neurology 2nd Edition is out! This labor of love, rewritten 10 years later with one of my most treasured mentors, Dr. José Biller, remains committed to making neurology the most exciting field of medicine.
#Neurology
@AANMember
@LoyolaMedMD
@uofcincy
10
26
208
Donanemab in early symptomatic Alzheimer's disease - Infographic of the phase 3 trial data published by JAMA earlier today.
Highlights:
• No improvement
• ~3-point less worsening in iADRS (below MCID)
• 3.4% slower decline (not 35%!)
@alzforum
@alzassociation
7
78
197
With immense pride, I am honored to announce that one of the brightest
@UCincyMedicine
former fellows, Dr. Abhi Mahajan (
@AMahajanMD
), will return to Cincinnati to join our faculty as of September. We celebrated in Boston on the eve of
#AANAM
2023.
Welcome back, Abhi! 🥳🎉
20
5
176
Population screening for bradykinesia.
10
28
169
You are normal but tested positive for amyloid. Will you get dementia? Here is your Essential Consumer Guide.
10
56
170
#Alzheimers
can’t be defined by Amyloid, the 9-to-1 winning argument by
@MayoClinic
David Jones, who argued that a disease does not exist without symptoms and brain dysfunction. The brave new “biological definition” world of AD will not prevail.
#AANAM
2024
4
42
161
The brain needs cholesterol.
More so a
#Parkinsons
brain?
The unspoken conclusion of the PD-STAT trial: cholesterol reduction is not desirable and may be detrimental.
We need to clarify this: many
#PwP
without heart disease are on prophylactic statins!
14
54
159
The first success in
#Alzheimers
comes with a caution: Lecanemab is one of 15 drugs that have markedly reduced amyloid. It is the only one that increases soluble (normal) Aβ42. Also, the benefit is below "clinically meaningful" (-1) on an 18-point scale.
8
56
157
Analyzing data from 8 anti-amyloid antibodies and 23,202 subjects, you'd need a magnifying glass to see something good. The conclusion is disarmingly simple: the benefits are imperceptible. Removing amyloid in
#Alzheimers
is not worth the risks
@AnnFamMed
10
43
152
I presented "The Illusion of Progress: Lecanemab in Alzheimer's disease" as a Grand Rounds this week at
@UCincyMedicine
. The responses to these 3 questions suggest the ground is readying to move Alzheimer’s research in a better direction. 👇
#Alzheimers
#lecanameb
7
44
151
Never before had the American Academy of Neurology advertised a drug in its annual Congress. The first
#AANAM
plenary started with a 5-minute video on how to deliver lecanemab to patients with
#Alzheimers
. As
@AANmember
I feel betrayed. The AAN sold some of its soul today.
12
27
152
#Amyloid
, an
@US_FDA
Cinderella story:
~75% of 42 anti-amyloid trials lowered amyloid.
~40% of patients worsened vs. placebo.
(Red cells in table;
@journal_ad
)
But post-hoc analyses of cherry-picked data can change everything.
#FalseHope
@EricTopol
@schor_n
@alzassociation
11
75
147
Never too early. The
@NIH
will no longer co-endorse the updated
#Alzheimers
guidelines with the
@alzassociation
. Does the NIA recognize that Amyloid Isn't Alzheimer's? A refreshing dose of governmental sobriety.
@forbes
10
28
137
In two decades of anti-amyloid trials in
#Alzheimers
(2002-2023), placebo emerges as the historic winner.
Do No Harm:
#Lecanemab
is an accident, not a victory.
Presented today at
#ASENT
, Bethesda,
@ASENT_Org
.
4
36
139
The triumph of evidence over blind hope.
Aducanumab will not harm Europeans with
#Alzheimers
.
4
32
136
When we see the
#lecanemab
and
#donanemab
data for what it shows rather than for what we want to see, there is no net benefit for patients with
#Alzheimers
. The risks of brain edema, hemorrhage, and accelerated brain atrophy are high.
"The small & uncertain benefits, the worrisome & poorly understood risks, & the very high costs of treatment suggest that these drugs are promoted largely out of theoretical rather than practical benefits" -
@AlbertoEspay
@KasperKepp
@KarlHerrup
hold no punches - caveat emptor!
2
14
35
6
54
136
Brain amyloid is a sign of healthy aging.
Let me explain.
APOE alleles yield the strongest genetic risk factor in
#Alzheimers
APOE ε2 lowers AD risk
APOE ε4 increases AD risk
If amyloid is toxic:
APOE ε2 should decrease amyloid
APOE ε4 should increase amyloid
Well... (1/3)
5
33
134
α-synuclein is a ubiquitous protein with many functions. Reacting against biological, toxic, or infectious exposures, it transforms into Lewy pathology, and its levels drop. How many studies seek to replenish α-synuclein to its normal levels? Zero
5
19
130
A classic sporadic disorder,
#ProgressiveSupranuclearPalsy
, revisited with a genetic prism. Includes a thoughtful decision algorithm for the clinician.
Great work by Iñigo Ruiz-Barrio, Javier Pagonabarraga (
@javipagor
), Jaime Kulisevsky and colleagues.
6
44
130
Another sacred cow of clinical practice is heading to the slaughterhouse. Low-dose aspirin for primary prevention of strokes in older adults does not prevent strokes and increases the risk of intracranial bleeding.
3
46
132
Nobel Prize winner Thomas Südhof endorses the proteinopenia hypothesis (loss of Aβ) in Alzheimer's.
Did you catch Nobel Prize winner Thomas Sudhof’s presentation?💡
“One plausible hypothesis is that Aß plaques are Aß sinks that lower the free Aß concentration, and that it is the loss of free Aß instead of an Aß toxicity that promotes AD pathogenesis”
#ADPD2024
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13
90
6
20
124
Carta abierta a mis queridos pacientes con enfermedad de Alzheimer.
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44
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My hypothesis: rivastigmine's cognitive effect is lower in
#Parkinsons
patients with orthostatic hypotension (OH) because of associated cerebral hypoperfusion.
I was wrong: Rivastigmine yields greater cognitive benefits in patients with OH.
Here is why:
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31
123
A
#Neurology
-inspired Christmas —time to learn about
#cognition
and
#behaviour
from the wisdom of hindsight.
This was a labor of love from several of us, most notably
@fedrodriguezp
!
Newly available by
@CambridgeUP
:
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18
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If
#Parkinsons
is not one disease, why do we research it as if it is?
If
#Alzheimers
is not one disease, why do we research it as if it is?
When will Neurology start living by the principles of precision medicine?
6
13
120
FDA: “It is expected that the reduction in amyloid plaque will result in a reduction in clinical decline.”
False assumption: Amyloid is not a cause of
#Alzheimers
, but a consequence. Reducing it just chases a tail.
#HopeOverScience
8
27
119
Avoid using Lecanemab (
#Leqembi
) or Donanemab (
#Kisunla
) for Alzheimer's. Important advice from the College of Family Physicians of Canada (
@CFPC_e
).
Evidence behind their conclusions:
@alzassociation
@alzforum
#Alzheimers
6
31
124
Should the aggregated proteins continue to define (and be targeted for) neurodegenerative disorders? 2019 offers sobering lessons. Identifying the biology that triggers aggregation may be the overarching need for the 2020s.
@EricTopol
#Alzheimers
#Parkinsons
@NINDSdirector
6
56
115
Clinical clues to suspect autoimmune ataxias. A nice review of the field by
@MayoClinic
’s Alfonso Sebastian at
#AANAM
.
3
25
115
#Donanemab
for
#Alzheimer
, misleadingly spun as positive: “donanemab resulted in a better […] ability to perform activities of daily living than placebo at 76 weeks”. The data suggest otherwise. (1/8)
#EliLilly
@NEJM
#ADPD2021
In a phase 2 trial, patients with early Alzheimer’s disease who received donanemab, an antibody that targets amyloid deposits, showed a better composite score for cognition & ability to perform activities of daily living at 76 weeks than those who received placebo.
#ADPD2021
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230
636
6
53
114
“Stuttering-like” dysarthria and speech arrests due to myoclonus of the craniofacial region is a disabling iatrogenic complication in
#Parkinsons
patients that resolves upon amantadine discontinuation. Hence, quite important to recognize!
@MDCP_Journal
2
25
113
"Clarity" on
#lecanemab
for
#Alzheimers
.
Can we sell patients a biweekly infusion that is neither safe nor effective? And if narrative prevails over evidence, can we afford it? An excellent editorial in the
@GreenJournal
.
4
27
114
Neurology's most enduring, always shattered dream: diverging slopes between treatments within the window of trials predict greater effects beyond them.
(1/5) Donepezil: had it not been for the washout period, this 24-week trial seemed disease-modifying.
5
38
105
I am grateful to the fantastic
@TEDxWrigley
team for making my TEDx about
#Parkinsons
and
#Alzheimers
the recipient of two Telly Awards (Silver for Social Impact and Bronze for Documentary) 🙏
The 15-min presentation is nearing 108K views!
8
10
104
Higher levels of soluble Aβ42 predict normal cognition better than lower amyloid burden among
#Alzheimers
-causing mutation carriers. Key data and implications from our latest analysis (1/9).
@journal_ad
15
31
103
Synuclein will soon be replaced by tau as the center of the
#Parkinsons
universe. A new paradigm? An editorial in
@Brain1878
co-written with Andrew Lees (
@ajlees
).
2
35
102
Brain proteins have functions; they are not toxins.
Losing normal proteins in
#Alzheimers
is consequential.
In the wake of the lecanemab announcement,
@Kariem_Ezzat
's latest blog may well be his most timely and relevant.
4
24
103
Lecanemab is neither safe nor effective for Alzheimer's patients. Add your name here against the FDA approval of this drug.
via
@Change
.
16
31
99
The discovery of IgLON5 promises the uncovering of a (treatable) subtype of antibody-mediated neurodegeneration. The higher rate of false positives in autoimmune panels, however, is a challenge to overcome. One of the best talks at the
#MDSCongress
@movedisorder
4
13
100
Wow. NOTCH2NLC GGC repeat expansions (neuronal intranuclear inclusion disease [NIID]) account for 20% of "adult-onset genetically undiagnosed nonvascular leukoencephalopathies" in Taiwan.
In-press article at
@Brain1878
2
24
96
Another sacred cow of neuroscience heading to the slaughter: the serotonin theory of depression.
10
21
92
Hypothesis: High tau causes dementia.
Experiment: Lowering tau with Semorinemab.
Population: prodromal/mild
#Alzheimers
.
Results: Tau lowered; cognition unchanged.
Conclusion? "More studies are needed"!
(1/4)
4
29
93
The hypothesis that amyloid is toxic was tested in the ‘A4’ trial. The anti-Aβ monomer antibody solanezumab numerically worsened cognition vs. placebo over 4.5 years in people with brain amyloid without symptoms. A summary of the data (1/12).
3
29
93
Motor neuron disease, cerebellar ataxia, and dysautonomia have a new causal gene, ZFHX3, which generates a trinucleotide GGC repeat expansion as the basis for SCA4. Will this become the first polyglycine disorder in humans? Excellent work by the Karolinska Neurology team!
Spinocerebellar ataxia type 4 is caused by a GGC expansion in the ZFHX3 gene and is associated with prominent dysautonomia and motor neuron signs
#medRxiv
1
9
20
3
20
91
Wishes for
#Parkinsons
research in 2023:
No biomarker will increase understanding "of PD"
No medication can slow "PD progression"
No epidemiology finding becomes a treatment target
What is common in a cohort cannot be relevant to everyone affected.
#ParkinsonIsNotOneDisease
8
14
91
We are treating Alzheimer's as if it were cancer. It isn't. The brain still shrinks at any level of amyloid detection, as
@Kariem_Ezzat
reminds us. Amyloid is a normal reaction to pathogens of various kinds. By shooting the messenger, we only create the illusion of success.
Since this analogy is used a lot, two major & fundamental things about amyloid plaques make Alzheimer's nothing like cancer. 1. Volume. 2. Reactivity.
1. Volume: The total amount of Aβ in the brain doesn't exceed 10 mg (6.5 mg, PMID: 28383676). 1/8
2
7
32
4
23
88
Important data-mining study supporting the existence of a major infectious subtype of
#Alzheimers
and other neurodegenerative disorders. Immunization against viruses make better sense than against brain proteins (amyloid-beta or alpha-synuclein).
11
28
87
In fluctuating
#Parkinson
patients, 3X/daily ER levodopa (IPX203) extended good ON time more than 5X/daily IR levodopa. IPX203 per-dose gain of 1.6 hours over IR levodopa suggests a 5X-to-5X IR-to-ER conversion will be wisest once IPX203 is available.
5
20
82
Amendments to a Schulz cartoon.
Do not “Trust the science”, trust the scientific method.
Do not “Question science”, question the ideas driving science.
Questioning ideas is how you do science!
3
20
84
It mimics
#ALS
, but bibrachial amyotrophy can be a complication of a chronic spontaneous spinal CSF leak without orthostatic symptoms. It is important to emblazon this case in our memory to avoid ever missing anyone!
1
24
83
Synucleinopenia and the Origin of Parkinson's Disease -the final and unrestricted version just published.
@ajlees
@PRDAssociation
@movedisorder
@ScienceofPD
5
28
84
2021 has begun with the same old approach of the past 4 decades:
#Parkinsons
continues to be approached as one disease, each discovery treated as a "piece in a puzzle".
There is no disease, but people with it. Each is a different puzzle. Who any of these findings apply to?
Should the aggregated proteins continue to define (and be targeted for) neurodegenerative disorders? 2019 offers sobering lessons. Identifying the biology that triggers aggregation may be the overarching need for the 2020s.
@EricTopol
#Alzheimers
#Parkinsons
@NINDSdirector
6
56
115
8
28
79
I am delighted by the extensive coverage of our article (Altmetric score 687, 83 news stories in the last 2 days) but, I must wonder, has such attention been artificially magnified by describing it as a "Shocking Study"? 😅
9
11
79
The clinical trial of tilavonemab for
#PSP_ProgressiveSupranuclearPalsy
offers definitive proof that the anti-tau strategy is wrong. A cautionary tale, also for
#Alzheimers
, in 9 parts (thread).
6
22
79
The case for changing the approach in
#Parkinson
disease research from lessening the proteinopathy (accrual of amyloids) to correcting the proteinopenia (depletion of normal proteins) --with
@MichaelOkun
, via
@JAMANeuro
.
2
25
77
Amyloid is a messenger –no need to kill it. In my TEDx talk, I show how proteins transform into amyloids and argue in favor of tapping into the therapeutic potential of restoring normal protein levels in those living with
#Alzheimers
and
#Parkinsons
.
6
24
76
A neurological wonder: 3 patients with criss-cross gait associated with Glut1 deficiency syndrome —some previously mislabeled as functional gait disorder.
Another jewel by
@kailashbhatia
with
@FraMagrinelli
#FND
@MDCP_Journal
4
19
76
Question to
@US_FDA
:
If a reduction in
#amyloid
plaque burden “is expected to attenuate clinical decline” and can now be considered an adequate measure of efficacy in
#Alzheimers
, for how many drugs can approval be sought retroactively?
Answer: 17
(1/6)
@alzassociation
2
31
73
Hence, the benefits may not be because of a reduction in amyloid but because of an increase in the levels of the normal protein. As such, this report does not “prove the amyloid hypothesis” as noted by Haruo Naito, Chief Executive Officer at Eisai, in the official release.
6
8
72
The best test of the amyloid hypothesis? A long-term trial of an anti-amyloid antibody in people with a PSEN1 mutation predicting
#Alzheimers
by age 44 but still normal.
Completed. Result: futile.
If this is not the final nail in the amyloid hypothesis coffin, no nail will do.
6
10
74
Omaveloxolone for Freidreich ataxia. The curves nicely separated in the double blind phase of the pivotal trial and did not converge in the open label extension. It passes the stringent bar for disease modification, it appears.
#AANAM
2
11
74
Humanity's largest non-IRB-approved experiment with the clearest answer: vaccination rates and Covid-19 mortality are inversely correlated.
4
33
71
The Existential Essentialism in Tremor Nosology − 7 Pitfalls, 2 Remedies, and a Path Ahead
Musings with
@DrAlfonsoFasano
on "essential tremor", a made-up entity without genetic, biological, electrophysiological, or pathological signature.
4
20
71
There is no lecanemab "improvement" but a little less worsening, by -1.21 with lecanemab, -1.66 with placebo. The 0.45 difference is below what can be perceived (1-2 points). There is no “27% improvement” but a puny 2.5% slower decline.
@schrag_matthew
The much trumpeted "27% slowing" is a relative value - the absolute difference on this test was 2.5%. In this image, I have re-scaled the result from the NEJM paper to include the absolute difference. [Values approximated using a graph extractor.]
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52
227
9
17
72
Hypothesis: Aβ42 is toxic.
Task: Lowering Aβ42 levels before
#Alzheimers
onset.
Trial: Anti-Aβ42 prophylaxis in NORMAL people with amyloid plaques (A4 Study).
Results at 10 years: Futile.
Conclusions: More aggressive anti-amyloid removal!
@LillyPad
8
20
70
Dream vs. Data. In the most used model of Alzheimer's, everything "goes up" as cancer. We have forever been trying to lower amyloid and tau. Our strong belief in the toxic-Aβ hypothesis (which can be 'adjusted' but never rejected) now threatens actual patients' lives.
1
15
71
Why does the idea of
#synuclein
toxicity continue to seduce us? This review is the latest example of the powerful hold of that narrative on
#Parkinsons
research. Some highlights. (1/7)
3
16
68
First order of business as Chair of the Pan American section of the Parkinson and Movement Disorders Society (
@movedisorder
): Touring the global headquarters in Milwaukee with the people who magically run it all. Pictured: Jenny Q, Maddy, Jennie, and Shannon. (1/2)
7
1
71
Only a thorough neurological exam can uncover functional neurological disorder complicating COVID infection. An important study from
@araceli_ac
, Isabel Parées, Juan Carlos Martinez-Castrillo, and the Madrid team.
@FNDSociety
@FndPortal
@FNDHope
#FND
1
19
69
“Saying autonomic dysfunction is almost meaningless” - David Goldstein, reviewing the increasingly complex Extended Autonomic System at
#AANAM
3
8
68
Dr
@AMahajanMD
delivered today an encyclopedic Neurology Grand Rounds on autonomic dysfunction in
#Parkinsons
and Lewy body disorders at
@UCincyMedicine
. Treating overlooked dysautonomia stands to greatly improve quality of life in our patients. 🙏🏻Abhi!
2
4
69
FND treatment begins with the neurological examination and is best poised for success when explaining its meaning to patients. A masterclass on
#FND
and a crash course on bedside delivery of cognitive therapy by
@PerezMGHLab
at the
#pascongress
@movedisorder
2
13
66
The field of quantum gravity research welcomes uncertainty and debate. Why does the field of neurodegeneration research discourages dissent? After another rejection (Reviewer 2: “the results are incompatible with the evidence”) reading
@carlorovelli
is a form of therapy.
10
3
65
Relative vs. absolute:
#Lecanemab
slows RELATIVE cognitive decline by 27% in
#Alzheimers
—an ABSOLUTE change of 9%. Are statins better? They lower the RELATIVE stroke/heart attack risk by 14% & 29% but the ABSOLUTE risk by only 0.4 & 1.3. Patients beware.
4
19
63
@foxmdphd
@MichaelOkun
@ParkinsonismD
@MedscapeLIVE
Slowness in the literature is often mischaracterized as "Parkinsonism." Many 'vascular parkinsonism' reports have been, upon closer inspection, neither vascular nor parkinsonian.
3
17
65
Levodopa mythology revisited — a 20-minute tour of the things we once believed about the most important replacement therapy in
#Parkinsons
.
4
26
64
IgG4 antibodies against a neuronal surface antigen (IgLON5) disrupt the dendritic cytoskeleton, minimizing response to immunotherapy. Is IgLON5 disease a Rosetta Stone for understanding “tauopathies” and neurodegeneration? Francesc Graus beaming his wisdom from Barcelona to Lima.
3
16
66
As I wait to board my departure flight, I relish the memories created in beautiful Dublin. They speak to our intertwined passions for friendship and science, and for the irreplaceable physical world we all inhabit. May we never be confined to living in a digital universe again!
2
3
66
We've heard this before. Gantenerumab lowered amyloid by ~50 Centiloids (like aducanumab) and increased CSF Aβ42 only by 26 pg/ml (not enough), yielding no benefits in
#Alzheimers
patients. via
@NEJM
. Editorial by
@LonSchneiderMD
.
6
18
65
In February, after the 'early' approval of
#lecanameb
, I discussed why amyloid isn't toxic, why the loss of Aβ42 is consequential, and why lecanemab and donanemab represent the illusion of progress.
@VuMedi
has just made this presentation freely available.
2
17
63
A major wish for 2022: Adoption of biological subtyping of patients with neurodegenerative disorders. Clinical
#Parkinsons
subtyping is inconsistent and does not align with underlying pathology or biology.
The MDS Task Force on
#PD
Subtypes set out to critically evaluate current PD subtyping systems. They released this systematic review in 2021 that assessed the methodologic quality and clinical applicability of various subtyping systems.
#MDSNeuroCompass
0
17
42
5
9
63
The functional vestibular disorder Persistent Postural-Perceptual Dizziness (
#PPPD
) was scholarly reviewed by
@MayoClinic
’s Dr. Jeff Staab at
#FNDS2022
. Chronic threat avoidance after vestibular neuritis disrupts connectivity between visual and postural control regions.
1
14
59
A government agency (SEC) discarded evidence that falsified the Madoff data for 8 years, to great harm. This Netflix series reminded me of another agency (FDA) dismissing evidence against the aducanumab and lecanemab data, made worse by
@alzassociation
ploys.
6
5
60
Headlines in
#Parkinsons
from posthoc analyses:
Rasagiline slows PD progression!
(1 mg)
Isradipine slows PD progression!
(no LOCF)
CoQ10 slows PD progression!
(Phase 2 subanalysis)
Latest:
Prasinezumab slows PD progression!
("diffuse malignant" subtype)
3
18
62
A large prospective study of LRRK2 carriers with and without
#Parkinsons
from
@23andMe
shows that LRRK2 G2019S is motor-dominant, slowly progressive, and has a lower prevalence of hyposmia, RBD, and cognitive impairment. Important study by
@lk_NYC_
(1/2)
1
16
62
A big surprise at tonight’s fundraising event (Chipping Away at Parkinson’s, organized by Paul Lake and Bob Dames [pictured]): Big Ash Brewery created the Espay’s Remedy beer. It sold out in no time! 😎🍺
3
0
62
How did neurodegeneration became equal to “protein accumulation” and CSF the brain’s toilet for “toxic proteins” flushed during sleep? Poor sleep “accumulates amyloid”, increasing
#Alzheimers
risk. But couldn’t amyloid just form as a reaction to the ‘injury’ of sleep deprivation?
4
5
62
A dream anti-amyloid trial in
#Alzheimers
? Lowering amyloid in those with genetically determined brain amyloidosis.
The DIAN-TU-001 trial sheds light on the unfalsifiability of the amyloid toxicity.
Can we break free? (1/13)
@alzforum
@alzassociation
3
21
59
Time to reject the hypothesis that alpha-synuclein aggregation is toxic.
@alpha_synuclein
@MichaelJFoxOrg
BIG NEWS from Biogen: Unfortunately, the SPARK trial of anti-synuclein mAbs in
#PD
failed to meet primary or secondary endpoints.
#Parkinson
’s
1
12
19
7
8
60
What do I enjoy most about lectures? The discussion. The intersection between
#FND
and
#Parkinsons
, first presented at the last
@FNDSociety
Congress, was just revisited with
@UBC
Neuropsychiatry Program colleagues. Things get interesting after min 35:00👇
9
7
60
Evidence vs. Belief in
#Parkinsons
and
#Alzheimers
:
Evidence: Proteins lose their function when aggregate.
Belief: Proteins become toxic when aggregate.
Treatment based on evidence? Replace normal proteins.
Based on belief? Remove aggregated proteins.
0
15
60