Contributed by Joshua D. Grill, PhD
A recent article in the New York Times highlights an important set of conundrums regarding amyloid imaging for Alzheimer’s disease. Amyloid imaging can detect with relative certainty whether beta amyloid plaques, which are a pathological hallmark of Alzheimer’s disease, are accumulating in a person’s brain.
Conundrum #1: Amyloid scans are not covered by insurance for people with cognitive problems. Research led by our friend Dr. Gil Rabinovici at UCSF has demonstrated that amyloid imaging can and does yield important guidance to clinical care. It can change diagnoses and instruct prescribing decisions (more on this >). We’ve also shown that it can provide meaningful information that may help families plan for the future (more on this >). It’s not clear what it will take for Medicare or insurers to start covering the cost of these scans for patients with cognitive problems, but work toward that goal is ongoing. UCI MIND hopes to help bring this and other diagnostic technologies to appropriate patients as rapidly as possible.
Conundrum #2: Amyloid imaging identifies amyloid plaques in the brains of about 25% of older people with no cognitive problems, suggesting their risk for Alzheimer’s dementia is higher. Perhaps fewer than half of these people, based on one previous study, may go on to develop dementia. So should older people who want to know if they are at risk for Alzheimer’s disease have the scan? Several points are important here. First, there is currently no way to prevent Alzheimer’s dementia. So, a physician can’t order an amyloid PET scan to identify patients who should take preventative therapies. Rather, the scans are essential to identifying candidates for clinical trials of potential preventative therapies. Some of these clinical trials are underway at UCI MIND now, and more are coming soon. Second, while there are a number of lifestyle recommendations that can be made to lower dementia risk, they are no different for people with vs. without elevated brain amyloid. Everyone should exercise, stop smoking, eat a healthy diet, and get adequate sleep. Third, we are in the early days of understanding the safety of sharing biomarker risk information. Our group and others have begun studying this, but there is much left to do. I personally believe there is a need to ensure safety for people undergoing these scans (or genetic tests), which means providing adequate education and counseling before and after someone chooses to undergo testing. To see an article I recently wrote about this, click here >.
Brain scans remain a critical topic in Alzheimer’s disease research right now. Technology is advancing, as is the way we use these tools to diagnose and study disease. Dr. William Jagust from UC Berkeley will be presenting on this topic at our 30th Annual SoCal Alzheimer’s Disease research Conference on October 25th. And if you missed our most recent Facebook LIVE episode on brain scans for Alzheimer’s disease with Dr. Craig Stark, you can view the video on our YouTube channel.
Dr. Grill is an Associate Professor of Psychiatry & Human Behavior and Neurobiology & Behavior at the University of California, Irvine. He is the Director of UCI MIND and Associate Director of the UCI Alzheimer’s Disease Research Center (ADRC). He also directs the Outreach, Recruitment, and Engagement Core for the ADRC and is leads the Accrual and Retention Consult Service for the UCI Institute for Clinical and Translational Science. His research is currently focused on clinical trials across the spectrum of Alzheimer’s disease. He has published a number of important findings on trial design, recruitment and retention, and research ethics.