Screening for Alzheimer’s is a diagnostic bridge to nowhere

Doctor, do you really want to know if your patient has a chronic, slowly progressive, fatal, debilitating disease for which you have no effective intervention?

Patient, do you really want to know if you have a chronic, slowly progressive, fatal, debilitating disease for which medicine has no effective intervention?

If you two together (along with family members) answer yes to that question, then the florbetapir-assisted PET scan of the brain for amyloid is for you.

If the FDA follows the advice of the advisory committee, once the manufacturer succeeds in running its new product through a few more hoops, you can find out with substantial certainty whether the patient has amyloid brain plaques and thus presumptive Alzheimer’s disease.

Then what? Nothing medical.

I am glad if finally there really will be a definitive way to diagnose amyloid plaques characteristic of Alzheimer’s prior to autopsy.

I believe that there can be real value in having such a test available in order to study the effects of rational potential drug therapy on the progression, or ideally the stabilization or regression, of the amyloid plaques.

But that is research, after fully informed consent, presumably usually in a setting of clinical trials.

As I wrote and spoke a few months ago, I implore physicians and patients to resist the inevitable marketing hype to use this test in any setting other than research.

It truly is a “Diagnostic Bridge to Nowhere.”

George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.

Originally published in MedPage Today. Visit MedPageToday.com for more health policy news.

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  • George

    One minor advantage I can see is more realistic planning for patients and families. Granted, unless you are immortal, end of life issues should be discussed sooner rather than later, but if those involved know that the POA will have to be executed sooner, it may make the decision making easier.

  • Smart Doc

    There are, first of all, a number of other dementias that need to be differentiated from Alzheimers: Frontal-temporal dementia, Lewy Body dementia, Creutzfeldt-Jacob disease, and the wide variety of metabolic and other sources of coignitive dysfunction.

    Once a diagnosis is established, there are a number of treatments for Alzheimers and for Alzheimers associated depression that are available in the armamentarium of every family physician.

  • Sarahw

    This is the most specious argument against testing I can think of. Diagnosis is an end in itself. Patients who want to know their condition should have access to a test that can tell them what their medical condition is and/or is likely to become, even if this test is self-pay.

    Patients can anticipate what is to come, and for alzheimers patients in particular it enables choices before the power of choice is gone for the individual.

    Do I take that trip now? How do I invest my money? Do I keep abreast of medical developments or put my attention to something else? Do I make plans for coping with my condition? Do I help my family prepare? Do I begin my search for hospice? Who will be my caregiver?

    That’s just the short list of items a diagnosis can inform.

    This author, somewhat arrogantly, assumes that no one wants to know or can get any treatment benefit from early diagnosis when there is no cure to be had. He’s wrong. Flat wrong.

  • Qwerty

    The question is should we borrow $5-7,000 from China for each test which has little significance so that our grandchildren can be saddled with more debt.

  • Ralph

    There’s a big difference between “treatments for Alzheimers” and something that actually can be reasonably expected to slow down the progression of the disease. The effectiveness of the currently approved drugs for Alzheimers in the USA is a roll of the dice. A shame, but Big Pharma is raking in the profits from Aricept before it finally goes generic.

  • mc

    The physician might want to start a Namenda and Aricept cocktail with mabe vitamin E or some of the Bs. Offspring might be helped to know what they may be trying to avoid-like hypertension, obesity, untreated atrial fib., etc. which a differential diagnosis might really help. A head full of lacunar strokes can look just like Alzheimer’s but is more preventable than a head full of beta amyloid plaque. If nothing else, long term planning and possible placement could start early to ease the adjustment.

  • Carolyn Smith

    I agree with George and Smart Doc that the testing and diagnosis can be very helpful, for LTC planning, end of life wishes, and treatment, such as it is. What if the person just needs B12 shots?

    However, if providers were more willing to have difficult discussions with their elderly clients (AKA Sarah Palin’s “death panels”), this type of testing may not be necessary.

    An example would be a couple with one partner showing dementia, and refusing to acknowledge or let go of financial matters. This is a delicate situation and a scan and test that shows dementia could be a way to validate the partner’s concerns. An MD diagnosis, presumption or otherwise can have a lot of weight and prevent financial ruin, and possibly save lives (dementia and driving is an example).

    My mother has had progressive vascular dementia for years but wanted to manage her rental property without input from us. She approved an owner finance/renter occupancy deal to a set of renters to sell a $300,000 plus property. The renters not only did not follow through with purchase but also destroyed the house, and we had to clean up the results. Another tenant left another property unattended and unheated in winter and caused $12,000 in plumbing costs. A clear diagnosis of dementia might have prevented these problems.