An Alzheimer’s Diagnosis—Before Any Symptoms - WSJ

[Fc1345linville]

Interesting article, likely to be controversial.

https://www.wsj.com/articles/an-alzheim ... 1505268481


Fc

[KatieS]

Thanks Fc for posting this article related to the use of amyloid scans. Troubling if drug studies use the amyloid clearing on the scan and not the more intensive cognitive testing and long-term follow-up, since we know that a brain can have lots of amyloid, but it might be the tau tangles that might create major impairment.

This quote stuck me as reaching out to our group:
“It’s critical to get feedback from the vast majority of people who’d be affected by this about being labeled as having Alzheimer’s disease when in fact they have no symptoms of Alzheimer’s disease,” says Dr. Glymour. (UCSF)

[Harrison]

Lots of layers here.

I think it is ridiculous to actually label someone as having Alzheimer's disease with no cognitive symptoms. Amyloid load does not correlate very well with cognition and Tau correlates better.

Medicare is trying to determine if they should pay for amyloid imaging. On the pro side, it will help with research and possibly initiate earlier lifestyle change. On the negative side, there are no medications that would justify the use and it is expensive.

The only asymptomatic people that it would make sense to get an amyloid scan would be an E4 carrier. And then a Tau scan after that would be helpful whenever one gets FDA approval.

I understand where the proponents are coming from because it would really help drive the science. If we didn't have an insurance system with things like pre-existing conditions, perhaps it wouldn't be as big of an issue, but still makes no sense to label cognitively normal people.

[circular]

Clearly the NIA is remiss in not having one of us on their committee! Seems tau may be a better marker and cognitive outcomes shouldn't be left out. But is the system were sensible I tend to be in favor of calling it 'pre-clinical Alzheimer's' if not 'Alzheimer's'. If someone has asymptomatic cancer or heart disease it's still called what it is. Anything to create wakeup calls/calls to action as long as it's an accurate label. I don't have a problem with 'pre-clinical Alzheimer's', but then it should be pre-clinical heart disease or cancer and that makes no sense because it downplays the urgency.