Tuesday, September 24, 2013

A Conundrum in Early Detection

The ability to detect Alzheimer's earlier has advanced quite a bit since we started this blog in 2011.  Now, individuals who are just starting to suspect something may be wrong have a better chance for an earlier diagnosis as a result of such techniques as using a PET scan to identify tau clusters in the brain.  A chemical which binds to the tau and makes them visible to the scans is given to the patient, allowing doctors to identify Alzheimer's signatures in living patients.  The same type of scan can be done with a chemical which binds to beta amyloid.

Screening programs which include cognitive evaluations are being actively debated because of the recognition that the number of cases of Alzheimer's will increase in the coming years.  The goal is to identify individuals before they are symptomatic in the hopes that early intervention with medication will slow the progression of the disease.  Unfortunately, there is no clear evidence to date that early intervention actually works to slow the disease.  We do know, however, that there remains no cure and we have yet to find a real preventative course as well.

Aside from the grim prognosis, there's another issue with early detection; misdiagnosis.  We often forget that individuals can have clumps of beta amyloid in their brain while remaining asymptomatic of Alzheimer's.  They never develop the forgetfulness or cognitive decline in skills which accompany the disease.  Even individuals with mild cognitive impairment may progress no further into Alzheimer's.

So, if you have such a person and you tell them they have an incurable, devastating disease, what harm is done to that person?  How will this impact their job or their familial or social relations?  Will their diagnosis lead to social isolation even as they remain fully functioning?  Will all subsequent life and medical decisions be impacted by a diagnosis of potential Alzheimer's even if the patient remains asymptomatic?

I don't have answers to these questions.  However, I do believe that it is a decision each person should make in careful consideration with their physicians.

1 comment:

  1. I think that earlier detection of Dementia will be of great benefit to the aging population.Not only will early treatment help slow down the illness, but a lot can be learned about prevention.The elderly is a large group of people who have a lot to offer. I am very pleased to hear about any kind of research being done in this needed area.

    Dementia specialist

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