生物与医学2021ncbi.nlm.nih.gov
认知衰退的逆转：一种新型治疗方案
Reversal of cognitive decline: A novel therapeutic program
入门 · 约 45 分钟读完前置知识：阿尔茨海默病基础知识、临床研究方法学基础
导读
这篇论文由 Dale Bredesen 提出，声称通过一套综合的生活方式干预方案（饮食、禁食、运动、补充剂等）可以逆转阿尔茨海默病相关的认知衰退。论文报告的是小规模病例系列结果，而非随机对照试验，其有效性在学界存在很大争议。
HN 关注点：是因为阿尔茨海默病缺乏有效疗法，而该方案声称能'逆转'认知衰退，讨论焦点集中在证据质量与商业化利益冲突上。
HN 评论精选
这几条评论里：质疑 3 补充 1
质疑引用《柳叶刀》驳斥文章，指出该方案缺乏证据、发表期刊可疑且存在未披露的商业利益冲突
《柳叶刀》对该方案有一篇彻底的驳斥：尽管书名副标题言之凿凿，目前没有任何已发表的研究检验或证明 Bredesen 方案能预防或逆转认知衰退。纳入的受试者为主观认知障碍或轻度认知障碍患者，但这些状况可能有与神经退行性病变无关的病因。评估该方案的三篇病例系列发表在被一些人视为掠夺性开放获取期刊的刊物上（前两篇发表在曾登上 Beall 掠夺性期刊名单的 Aging 杂志）。此外该方案已商业化，但作者在科学报告中未披露任何利益冲突。
jasonhansel查看英文原文
A thorough debunking of this protocol from The Lancet: https://sci-hub.se/downloads/2020-04-23/63/10.1016@S1474-44222030113-7.pdf A few quotes: > Despite the certainty inferred by the book’s subtitle, there is no published study that tests or proves the hypothesis that the Bredesen protocol can prevent and reverse cognitive decline. > Readers are informed that participants with subjective cognitive impairment or mild cognitive impairment are included in the studies; however, both conditions can have causes unrelated to neurodegenerative processes. These studies are therefore not targeting a common underlying neuropathological process of Alzheimer’s disease, as the papers suggest. > Readers might not be aware that the three case series evaluating the Bredesen protocol appear in journals considered by some to be predatory open access journals. [...] The journal Aging, where the first two articles were published, appears on the Beall’s list of potential, possible, or probable predatory open access journals [...] > it is notable that the Bredesen protocol has been made commercially available; however, the authors do not disclose any conflicts of interest in their scientific reports.
补充辩护：虽然证据不足，但建议本身健康无害，且现有疗法同样无效
很多评论因缺乏证据而直接否定它，但现有阿尔茨海默病常规治疗也没什么用。方案建议的生活方式调整大多是健康的、不难做到，还有其他健康益处。这些习惯本身也不常见，广泛采纳加上检测霉菌毒素、重金属等或许能带来一些边际收益。除了减掉肚腩、保证睡眠和运动之外，没有太多理由忽视这些主要建议。附上 Rhonda Patrick 对 Bredesen 的访谈。反正没几个人会真正执行这套方案，时间会证明它是否有用。
krrrh查看英文原文
Lots of comments dismissing this out of hand because of lack of evidence, but there aren’t any conventional treatments that are very helpful for Alzheimer’s. The lifestyle adjustments suggested in the protocol are largely healthy, not that hard to do, and offer other health benefits. They are also relatively uncommon so it’s not impossible that a broad based adoption of specific habits along with testing for mycotoxins and heavy metals, etc could provide some marginal benefits. Aside from maintaining your spare tire and fatigue from not getting enough sleep and exercise, there’s not much reason to ignore the main advice. Anyway, here’s a Rhonda Patrick interview with Bredeson for the curious. So few people will actually do the protocol, time will tell if there’s anything to it. https://www.foundmyfitness.com/episodes/dale-bredesen
质疑指出该论文被后续文献作为未经验证治疗的反面案例
看起来像是炒作，这篇文章被其他论文引用为'未经验证的治疗'的例子，另有一篇论文对它提出了严厉批评。
someguydave查看英文原文
Seems like hype, this article was cited by others as an example of non-validated treatments https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7935739/ and another paper that criticizes this paper heavily https://pubmed.ncbi.nlm.nih.gov/33459944/
质疑质疑：方案内容像是流行健康趋势的拼凑，令人难以信服
也许我太多疑，但'神奇疗法'恰好是过去十年各种健康时尚的大杂烩——无麸质、间歇性禁食、瑜伽、褪黑素、益生菌等等——这实在难以令人相信。
wawayanda查看英文原文
Maybe I'm a cynic but it strains credulity that the miracle cure is also a laundry list of fad health trends from the the last decade. Gluten free, intermittent fasting, yoga, melatonin, probiotics, etc etc
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