A Brain Scan May Predict Alzheimer’s. Should You Get One?
Juli Engel was delighted when a neurologist recommended a PET scan to determine whether amyloid — the protein clumps associated with an increased risk of Alzheimer’s disease — was accumulating in her mother’s brain.
Her mother, Sue Engel, is 83 and lives in a retirement community in Florida. She’s been experiencing memory problems and the other signs of cognitive decline that her family could no longer ignore. There were, of course, the small things that drive us all crazy–losing our keys and wandering into rooms, then forgetting why we’re there. But for Juli, there were more serious indicators: Mom had been financially exploited, suffered an insurance scam and caused an auto accident. Time for an intervention.
PET scans can detect amyloid plaques that can indicate Alzheimer’s
PET scans can detect the amyloid plaques that occur commonly in older people’s brains that contribute to Alzheimer’s disease. Receiving an early diagnosis can be devastating to patients and their families, but it can help patients get their affairs in order and make the most of the time they have left. They can begin taking medications that may slow down the spread of the disease. Alzheimer’s can be a slow-moving illness, and early diagnosis gives patients time to join support groups, spend time with their families and learn how to live as fully as possible in their remaining years.
A PET scan’s downside
Amyloid plaques occur commonly in older people’s brains, but not everyone with amyloid will develop dementia. Nor does a negative PET scan mean someone won’t develop dementia. Medicare doesn’t cover the scans’ substantial costs of $5,000-$7,000.
The healthcare community debates PET scans: Few benefits at significant costs
Brain damage from Alzheimer’sbegins years before people develop symptoms, and worried patients and their families may start turning to PET scans to learn if they have this biomarker.
While scientists at Washington University in St. Louis have developed a blood test for amyloid that can predict the development of plaques in the brain, it is years away from everyday use in doctors’ offices.
Some experts fear PET scans offer few benefits, at substantial costs. Currently the criteria developed by the Alzheimer’s Association and nuclear medicine experts call for PET scans only in cases of unexplained or unusual symptoms and unclear diagnoses.
Even with detection, we have no corresponding treatment for Alzheimer’s
Alzheimer’s rates climb steeply at older ages, when people grow more likely to die of other causes before they can develop symptoms. But older people also may be among the 30% or so of those with amyloid deposits who, for unexplained reasons, retain normal cognition. “If we start treating everyone with preclinical Alzheimer’s, what treatments would those be? Multiple trials have failed to find drugs that prevent, reverse or substantially slow Alzheimer’s disease, perhaps because these treatments were introduced too late in the disease’s course.
Concerns about broader acceptance
Some worry about “indication creep,” when a drug or test approved for patients with a particular condition becomes used for others. They also worry about crushing costs for Medicare. “Even if a scan cost zero dollars, I wouldn’t recommend it,” said Dr. Ken Covinsky, a geriatrician at the University of California, San Francisco. “Do you really want to know that you have amyloid in your brain, years ahead of cognitive problems that may never develop?”
PET scans can act as motivators
Proponents of making PET scans more widely available argue that knowing their amyloid status may motivate patients to make lifestyle changes. Stopping smoking, exercising and eating a healthier diet are all found to reduce dementia, even among those at higher genetic risk. Perhaps, too, patients will be more likely to begin advance care planning.
What the scan will mean for Juli Engel
For the Engels, the test delivers tangible results. Once the neurologist documents her mother’s incapacity, Juli can take steps to prevent her mother from driving; she’ll be able to move her into assisted living when needed. As a geriatric care manager, Juli thoroughly understands the trajectory of this disease. Because she also knows that both her maternal grandparents had Alzheimer’s, she is considering her own future, too. Does she have amyloid in her brain? Her family is full of scientists, and we tend to want to know these things,” she said.
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