[HN Gopher] Driving may reveal early signs of Alzheimer's
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       Driving may reveal early signs of Alzheimer's
        
       Author : bananapear
       Score  : 58 points
       Date   : 2021-07-13 09:13 UTC (1 days ago)
        
 (HTM) web link (www.bbc.co.uk)
 (TXT) w3m dump (www.bbc.co.uk)
        
       | spockz wrote:
       | > Specifically, those with preclinical Alzheimer's tended to
       | drive more slowly, make abrupt changes, travel less at night, and
       | logged fewer miles overall, for example. They also visited a
       | smaller variety of destinations when driving, sticking to
       | slightly more confined routes.
       | 
       | I wonder what the direction of the causality is. Maybe there is
       | something else that triggers the slow driving. Visiting the same
       | destinations regularly instead of varying ones might also just
       | point to a very routine lifestyle. Maybe that contributes to
       | Alzheimer's a lot? It feels a stretch to use these attributes as
       | casuals for attribution of Alzheimer's.
        
         | kortex wrote:
         | There have been some interesting findings in aging studies
         | (e.g. the 90+ study [0]) that suggest some people who have all
         | the physiological signs of Alzheimers, but show no symptoms of
         | dementia.
         | 
         | I suspect the arrow goes:                   X -> brain
         | degradation          brain degradation -> cognitive decline
         | cognitive decline -> driving bad         brain degradation ->
         | post-mortem Alzheimers diagnosis
         | 
         | The loose link there is the path from brain degradation to
         | cognitive decline. The 90+ findings (plus other findings on TBI
         | and plasticity) suggest that by maintaining high plasticity
         | through brain assaults (old age, trauma), it seems the brain
         | can "route around damage" and remain comparatively functional.
         | 
         | [0] The 90+ study: https://mind.uci.edu/research-
         | studies/90plus-study/
         | 
         | 60 Minutes on Superagers - Video + Transcript:
         | https://www.cbsnews.com/news/long-life-retirement-community-...
        
           | spockz wrote:
           | > [0] The 90+ study: https://mind.uci.edu/research-
           | studies/90plus-study/
           | 
           | This plasticity idea is really neat. Anecdotal and I don't
           | know the correlation holds up, but my one grandmother was
           | very set in her habits and particularly mindset and died
           | early of Alzheimer's and Parkinson's. My other grandmother is
           | flexible of mind and is still kicking it at 90+.
           | 
           | I'm wondering which way the causality goes. Whether there is
           | something physical which makes people more open minded and
           | wandering whereas others are more closed which eventually
           | leads to more brain diseases. So in the end the open
           | mindedness / flexibility is just another indirect indicator.
        
         | bachmeier wrote:
         | I think the goal is only to have an early warning of medical
         | issues, rather than finding a causal effect and preventing the
         | issues.
        
           | mannykannot wrote:
           | Without the measured changes being caused by Alzheimer's, it
           | is unlikely they will have any specificity. On the other
           | hand, the results reported here give at least circumstantial
           | evidence for this causality.
        
       | kian wrote:
       | Insurance companies will be all over personal data (search,
       | location, and profiles) so that they can statistically
       | discriminate against their clients beyond what they have been
       | thus far able. HIPAA is fairly toothless in many ways, and
       | doesn't even cover cases like this. It's time to start
       | implementing criminal penalties for illegally exfiltrating
       | private health data before it is too late.
        
         | hermannj314 wrote:
         | Isn't statistical discrimination the basis of fair cohort
         | definition in insurance underwriting?
         | 
         | What do you think insurance, as a financial product, is? An
         | entity looking to hedge against financial uncertainty relies on
         | being placed in a cohort that represents equivalent risk
         | profile to their own.
        
           | plainnoodles wrote:
           | I think insurance is nothing but a serendipitous, temporary
           | alignment of finance, levels of information
           | availability/tracking, and the fundamental right of all
           | humans to life and health.
           | 
           | Right now, despite their best efforts, insurance companies
           | are still fairly limited in their ability to discriminate and
           | exclude certain swathes of people from access to affordable
           | healthcare. Once they manage it, they become useless to us as
           | a society.
           | 
           | Ideally, we as a society want all of our members to be able
           | to see a doctor when they are sick or injured.
           | 
           | Ideally, insurance companies want to exclusively insure
           | people to whom they will never need to pay out. They optimize
           | their profit margin to be essentially 100%. Which then makes
           | them a leech, and they're probably a leech well below 100% as
           | well.
           | 
           | (To be fair, since the system is completely inhuman,
           | individuals will also play the same game and try to leave the
           | risk pool if they are sufficiently low-risk.)
           | 
           | So, there will come a time when we have to either give up any
           | facade that we value human health intrinsically, or we must
           | stop using private insurance as the primary method of
           | ensuring it (no pun intended).
        
         | bananapear wrote:
         | In the UK it's commonplace for insurers to offer "black box"
         | policies, where a small device including GPS and accelerometers
         | with an mobile internet connection must be fitted to the
         | vehicle in exchange for a discount.
        
           | carlhjerpe wrote:
           | I wouldn't place one of those in my car if it made the
           | insurance free. I understand why they do it(both parties),
           | but I also think it's disgusting.
        
         | atatatat wrote:
         | Google has the majority of it via legal means..., we need to
         | get a handle on our governments before we even try to protect
         | our digital info...
        
       | nazrulmum10 wrote:
       | Although this potential scenario is a long way off for the
       | insurance market, it's something that might worry existing owners
       | of black boxes who have already experienced issues with their
       | devices' accuracy in the past.
        
       | fortran77 wrote:
       | Google or Apple, who also know our location, can start targeting
       | Alzheimer ads to people.
        
         | [deleted]
        
         | amelius wrote:
         | First there must be products that target the disease.
        
           | Minor49er wrote:
           | Google can simply start marketing residential care ads to the
           | individual as well as their family.
        
             | ianbooker wrote:
             | I think their AI is already doing that.
        
           | fortran77 wrote:
           | Long term care? Insurance?
           | 
           | There doesn't need to be a cure or treatment for companies to
           | make money from it.
        
       | AnIdiotOnTheNet wrote:
       | > Specifically, those with preclinical Alzheimer's tended to
       | drive more slowly, make abrupt changes, travel less at night, and
       | logged fewer miles overall, for example. They also visited a
       | smaller variety of destinations when driving, sticking to
       | slightly more confined routes.
       | 
       | Aside from the abrupt changes this could describe my driving
       | habits. I hate driving, driving at night most of all.
        
         | Finnucane wrote:
         | Presumably there is some presumption that everyone in the study
         | has more or less the same driving needs. Possibly for a small
         | area in MO, that might be true, or at least close enough. I
         | mean, I don't drive much either, but I live in a place where I
         | don't have to. I don't need the car to get to work or do most
         | of my ordinary errands. Now, if they want to track my bike,
         | they might get more data.
        
         | WesolyKubeczek wrote:
         | Yeah, what if I learned to drive late in my life and am simply
         | not confident enough? Or maybe I take speed limits seriously?
        
         | xeromal wrote:
         | My take from the article is that the deviation happens over
         | time from your preexisting baseline. So it's not your current
         | habits, its that tracking your habits over time will show a
         | difference.
        
         | tines wrote:
         | I have some bad news for you buddy
        
         | jsight wrote:
         | I was thinking that these changes weren't described in specific
         | enough detail too. I mean, these could also be used to guess
         | age in general, if I'm reading it right.
        
       | ben_w wrote:
       | I know this is merely an anecdote, but this fits what I saw in my
       | mother. I was learning to drive, visited the parents, we went on
       | a practice drive... and she found speed sufficiently frightening
       | that she asked me to limit myself to 40 MPH, while we were on a
       | 70 MPH dual carriageway A-road. My driving lessons came with a
       | booklet saying doing under 50 on such a road (in normal
       | conditions) would be considered dangerous.
        
         | KineticLensman wrote:
         | > My driving lessons came with a booklet saying doing under 50
         | on such a road (in normal conditions) would be considered
         | dangerous.
         | 
         | Yes! A slow driver (under 50) can cause very high closing
         | speeds for drivers who aren't paying attention. A likely
         | accident scenario could be a driver who tailgates a white van
         | that is itself closing fast on the slow vehicle, blocking the
         | view of the tailgater (all are in the inside lane). If the van
         | makes a late overtaking manoeuvre (to avoid the slow vehicle)
         | rather than smoothly braking, the tailgater has very little
         | time to react, and depending on traffic density, might not
         | themselves be able to change lanes.
         | 
         | I saw this exact situation happen a few days ago. I was in lane
         | 2 about 100m further back down the road. The van changed lanes
         | at the last possible moment. The tailgater slammed on his
         | brakes and came very close to shunting the slow vehicle.
         | Luckily there was no-one behind him so a braking wave didn't
         | propagate back down the lane.
        
           | throwaway0a5e wrote:
           | I wish. Unfortunately the moron causing the hazard almost
           | never gets caught up in the resulting accident like you
           | describe.
           | 
           | What happens is you wind up with a merge (and all the
           | shenanigans that causes) behind the blockage and given a long
           | enough duration you eventually run into the case someone
           | doesn't check their mirrors/blind spot and hits someone who's
           | not on their A-game because there's no exit there and they're
           | not expecting the person to merge there.
        
           | iso1631 wrote:
           | Funny how you'd blame the slow driver rather than the driver
           | not paying attention and/or tailgating.
           | 
           | What if the "slow driver" was a normal driver who just got a
           | puncture and was slowing down?
        
             | throwaway0a5e wrote:
             | >What if the "slow driver" was a normal driver who just got
             | a puncture and was slowing down?
             | 
             | Then they'd have a good excuse.
             | 
             | Same with the shitbox running on 3cyl.
             | 
             | Same with the concrete truck that pretty much has to drive
             | under the prevailing speed uphill because it's so slow.
             | 
             | To voluntarily create a hazard when you can "just not" by
             | behaving like everyone else (which is not exactly an
             | activity that requires a lot of cognitive thought) is
             | simply asinine.
        
             | KineticLensman wrote:
             | Just to be clear, I didn't assign blame when describing my
             | little scenario. The slow driver is creating an avoidable
             | problem that increases the impact of the poor driving
             | behaviours exhibited by the other drivers (going too fast,
             | too close). All three are doing at least one thing wrong.
        
             | ceh123 wrote:
             | If the slow driver is fully capable of driving a normal
             | speed and makes the choice to drive well below the speed
             | limit, they are making a choice that directly increases the
             | probability of an accident (regardless of if they are
             | involved in the actual accident or not).
             | 
             | If the slow car has an issue that makes it so that they
             | cannot go any faster they should be putting their hazards
             | on and slowing down, in which case it would be the drivers
             | who are not paying attention's fault.
             | 
             | Really in both cases the drivers not paying attention share
             | some of the blame, but in the first case the slow driver is
             | _also_ being irresponsible.
        
       | wirthjason wrote:
       | Specifically, those with preclinical Alzheimer's tended to drive
       | more slowly, make abrupt changes, travel less at night, and
       | logged fewer miles overall, for example. They also visited a
       | smaller variety of destinations when driving, sticking to
       | slightly more confined routes.
       | 
       | Isn't this pretty much everyone as they get older? Who hasn't
       | seem these traits in older relatives?
       | 
       | Everyone I know who gets older tends to drive less at night
       | because as you get old your eyesight gets worse --- particularly
       | if you've had cataract surgery, which are people who are in the
       | study / risk group.
       | 
       | Unless I missed a more nuanced point this article reads like "old
       | age is a good predictor of Alzheimer's."
        
         | cogman10 wrote:
         | > particularly if you've had cataract surgery
         | 
         | Cataract surgery should improve night vision. Those with
         | cataracts generally have much worse night vision because their
         | vision is clouded.
         | 
         | If night vision is worse, it could indicate that the person
         | needs a follow up with their eye surgeon and possibly follow up
         | surgery to adjust the IOL.
        
         | WhompingWindows wrote:
         | I think the quote ties in with what else we know about
         | Alzheimers: it tends to develop in those with smaller social
         | circles, in those who experience less novelty and less healthy
         | lifestyles. If the person is out in society learning a new
         | language, meeting new people, learning a new instrument,
         | exercising their minds' regenerative capacities, that's a great
         | "counter" to aging.
         | 
         | If they're sitting at home, not driving anywhere, watching
         | cable news all day, that's a recipe for rutted-grooves of
         | thought and deterioration of the mind.
        
           | actually_a_dog wrote:
           | I tend to drive relatively little, visit fairly few distinct
           | places, and generally take the same route each time I visit
           | them. I'm also not a huge fan of night driving. I don't think
           | I drive particularly slowly or make too many abrupt changes
           | (I've never had an accident involving another car, am never
           | the slowest one on the freeway, and have never had a
           | complaint from any of my passengers).
           | 
           | The interesting part for me here is that these behaviors _do_
           | , in fact, reflect a neurological issue I have with
           | visual/spatial processing. In a nutshell, I get lost easily,
           | because it takes me much more time to associate visual
           | landmarks with a travel route than the typical human. I
           | suspect my dog has a far, far better sense of direction than
           | do I. :P
           | 
           | I'm not even close to old enough to have preclinical signs of
           | Alzheimer's, yet, but I shall have to remember to remind my
           | doctors of my visual-spatial issues in a few decades when I
           | am.
        
           | Kluny wrote:
           | Got a bit of a victim-blamey vibe here. Intuitively it makes
           | sense that if you're more active and social, you don't get
           | Alzheimer's - but it's also pretty tough to separate
           | correlation and causation. Does being shut-in cause
           | Alzheimer's, or do people end up being shut-ins because of
           | Alzheimer's? Intuition is often wrong.
        
         | 01100011 wrote:
         | Personally, my processing speed and reaction time fell off a
         | cliff in my early 40s. I used to be a more aggressive driver
         | but had to back off because I can't handle the flood of
         | information now. It's easy to overlook things and miss objects
         | and cars so I have to check twice.
        
           | bsder wrote:
           | > It's easy to overlook things and miss objects and cars so I
           | have to check twice.
           | 
           | How about: "You weren't as good as you thought, and you just
           | missed it when you were younger."
           | 
           | If you look at driving accidents, they fall continuously
           | until you are about 30. And they don't start rising again
           | until you are about 75-80.
        
           | neuralRiot wrote:
           | Interesting, I'm certainly older than that but i feel i can
           | still handle trafic pretty well but i drive slower because i
           | stopped giving a crap if i get late somewhere or i get out
           | earlier and i'm less aggressive because I realize it's
           | pointless. If that's getting old i'm happy with it.
        
         | KingMachiavelli wrote:
         | Age was another input into the model. However, it's no surprise
         | that the _signs_ of aging correlate strongly with Alzheimer 's.
         | While one 70 year old in very good mental/physical health may
         | be very active including driving, another may seem and "act" a
         | lot older.
         | 
         | In particular, Driving from point A to point B depends on a
         | certain kind of memory that degrades quickly in Alzheimer's.
         | Forgetting names is one thing but forgetting whole places is
         | another.
         | 
         | * Making abrupt changes: perhaps they are suddenly recalling
         | something they need to do like turn onto a certain street? Not
         | quite sure. * Driving at night removes a lot of visual cues
         | putting an even larger emphasis on memory. * Longer travels &
         | having more destinations both depend on memory so that one
         | makes sense.
        
       | rahulnair23 wrote:
       | From the full paper[1]:
       | 
       | > All models were trained on 70% of the data and tested on the
       | remaining 30% of the data. Note that each month record for each
       | participant was considered an independent data point.
       | 
       | I'm almost certain that this is a mining leak.
       | 
       | Data from one patient will end up both in the training and test
       | set and result in fantastic accuracy. Of course it will be from
       | different months. The correct way to do this is to cross-
       | validate/split across the population. It seems unlikely, from
       | this description, that the authors have done so.
       | 
       | [1]
       | https://alzres.biomedcentral.com/articles/10.1186/s13195-021...
        
         | mattkrause wrote:
         | Definitely.
         | 
         | It's a very common error and it _should_ be easy to catch
         | but....I 've even seen a study that treated individual slices
         | of an MRI as independent, which is laughably wrong.
         | 
         | I think part of the problem is that the "analysts" are
         | increasingly uninvolved in the data collection, and just treat
         | it as a tuple of (X, y). If you thought about what they mean,
         | even for a second, ("Oh, Mr. Smith is always an awful driver"),
         | the problem is obvious.
        
         | NwtnsMthd wrote:
         | I'm somewhat unfamiliar with the problem, do you think you
         | could explain why this is bad? Or maybe just point me in the
         | right direction? Thanks!
        
           | kirykl wrote:
           | Overfits for study participants. Will Not necessarily give
           | same results on gen pop
        
           | rahulnair23 wrote:
           | One way to tell if a Machine Learning model is any good is to
           | see how it does on unseen/new patients.
           | 
           | Of course, we don't wait to try it on real patients, so
           | typically you'd partition the data you have already into (a)
           | what you show to the machine learner (training data), and (b)
           | what you hide from the learner (test data). The latter is
           | only used to evaluate, i.e. you get the answer from the ML
           | model and compare it to the real answer you have already. If
           | information about the test data some how makes it to the
           | training data, its referred to as a mining leak [1].
           | 
           | In this paper, they treat each month of a patient as an
           | independent observation. However, GPS driver behaviour will
           | be very similar from one month to the next for the same
           | person. Genetic information is exactly the same. So for every
           | month that the model is tested (test data), the learner has
           | already seen very similar data in the training set - for some
           | of the other months (for the same person) that happen to be
           | in the training set. The split is typically done randomly. So
           | it will do well.
           | 
           | The test results are therefore optimistic and do not support
           | the conclusions.
           | 
           | [1] https://en.wikipedia.org/wiki/Leakage_(machine_learning)
        
           | CaptainNegative wrote:
           | Suppose that you have 3 data points, on June 14, 15, and 16,
           | that due to personal driving quirks all appear to belong to
           | the same person. If the 14th and 16th are in your dataset,
           | and both correspond to Alzheimer-free Bob, that may be a
           | strong hint that the data from the 15th is also Alzheimer-
           | free.
           | 
           | But this doesn't help you in the real world where you won't
           | necessarily have near neighbors corresponding to the same
           | person, with a known diagnosis.
        
       | fujidust wrote:
       | Autopilot-style driver aids can mess with these data points to
       | some extent. Still very interesting that diversity in destination
       | is considered an indicator.
        
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