Dr. Gary Small, M.D.

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Gary Small, M.D., is Chair of Psychiatry at Hackensack University Medical Center, and Physician in Chief for Behavioral Health Services at Hackensack Meridian Health, New Jersey’s largest, most comprehensive and integrated healthcare network. Dr. Small has often appeared on the TODAY show, Good Morning America, and CNN and is co-author (with his wife Gigi Vorgan) of 10 popular books, including New York Times bestseller, “The Memory Bible,” “The Small Guide to Anxiety,” and “The Small Guide to Alzheimer’s Disease.”

Tags: aging | Alzheimers | amyloid | PET scan
OPINION

Predicting and Managing Cognitive Decline

Dr. Small By Friday, 27 December 2019 01:33 PM EST Current | Bio | Archive

Being able to accurately predict Alzheimer’s onset and progression is valuable for successful treatment, and research on early diagnosis and risk factors is making valuable progress.

For instance, scientists reported that people with hearing loss have three times higher risk for mild cognitive impairment than those with normal hearing. Mild cognitive impairment is a form of cognitive decline that is more severe than the common minor memory slips that everyone experiences with normal aging.

Most patients with mild cognitive impairment have a 10 percent risk of developing dementia within a year.

Another study showed that following nonelective hospitalizations, older adults experienced a 60 percent faster rate of cognitive decline. The researchers concluded that these results have implications for medical decision-making and care of older adults.

Other researchers reported on how PET scans can impact patient management. The ongoing Imaging Dementia — Evidence for Amyloid Scanning (IDEAS) Study, is evaluating whether obtaining a PET scan has an effect on a patient’s clinical outcome.

These scans display levels of brain amyloid, one of the abnormal proteins that accumulate in Alzheimer’s disease.

Although the FDA has approved the use of these scans, they are not currently reimbursed by Medicare or private insurance because of a lack of data showing they can lead to practical clinical benefits for patients.

In an assessment of 4,000 older subjects who were Medicare beneficiaries, researchers evaluated whether obtaining a PET scan changed patient management — for instance, beginning to take anti- Alzheimer’s medication.

The subjects all had mild cognitive impairment (MCI) or atypical dementia (i.e., their clinical course was not typical for Alzheimer’s disease), which can be a very challenging diagnosis.

In 68 percent of the MCI patients, medical management was altered after the PET scan results; and in 66 percent of the patients with atypical dementia, management was changed.

These results suggest that amyloid PET scans alter patient management. A more important outcome would be to determine if use of the scans resulted in improved outcomes.

Another promising study involved a blood test to detect amyloid in the brain. Previous studies demonstrated a connection between Alzheimer’s disease and the accumulation of brain amyloid protein into plaques.

In fact, the presence of brain amyloid plaques is required for making a definite diagnosis of Alzheimer’s. Currently, the only way to identify amyloid plaques in living patients is through a brain amyloid PET scan or examining cerebrospinal fluid from a lumbar puncture.

Less expensive and less invasive tests for amyloid accumulation are needed, and scientists from Washington University School of Medicine presented promising findings on a small study of a novel blood biomarker for amyloid.

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Dr-Small
Being able to accurately predict Alzheimer’s onset and progression is valuable for successful treatment, and research on early diagnosis and risk factors is making valuable progress.
aging, Alzheimers, amyloid, PET scan
433
2019-33-27
Friday, 27 December 2019 01:33 PM
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