New Advances in Alzheimer’s Diagnosis: The Lowdown on Brain Amyloid Imaging

We’ve all heard the bleak story that the only way to absolutely be sure a person has Alzheimer’s disease is to examine the brain through autopsy. For decades, we’ve waited ever so patiently for a better way.

For some people with the disease, a piece of that better way might finally be here.

You may have heard of positron emission tomography (PET), a method of looking at organs in the body by using a special camera and a “tracer” (a radioactive chemical injected into the body that “lights up” areas of interest). For several years, scientists have been experimenting with PET as a way to see the icky, sticky brain plaques (scientifically known as beta amyloid) common in Alzheimer’s disease. And according to the Alzheimer’s Association and the Society of Nuclear Medicine and Molecular Imaging (SNMMI), this imaging technology is now available to actually see those plaques in living people.

Image courtesy of the National Institute on Aging and the National Institutes of Health

Image courtesy of the National Institute on Aging and the National Institutes of Health

Hallelujah! The availability of brain amyloid imaging is encouraging news, but it also must be viewed in context. Does it place us one step closer to the goal of fostering early diagnosis? Yep. Does it replace our current exhaustive diagnostic methods? No. PET is still only one piece of the diagnostic puzzle and should not be used as the only tool in making a diagnosis.

Perhaps even more importantly, doctors need to recognize when brain amyloid imaging should and should not be used in the diagnosis of Alzheimer’s. To help them do that, a task force created by the Alzheimer’s Association and SNMMI developed some nice, succinct guidelines. They outline three situations when this procedure is appropriate:

  • When the person reports persistent or progressive memory problems or confusion that cannot be explained by another diagnosis. The person must also show impairments in these areas through the administration of standard tests of thinking and memory.
  • When the person meets criteria for possible Alzheimer’s disease but is unique or unusual in his or her presentation.
  • When the person has a progressive dementia and the onset of symptoms occurred before the age of 65.

As you can imagine, brain amyloid imaging is not cheap. And because its use in the diagnosis of Alzheimer’s is new, it’s not covered by Medicare or private insurance when used for this purpose. The Alzheimer’s Association recommends that brain amyloid imaging be covered by the Centers for Medicare and Medicaid Service (CMS) when used within the stated guidelines and presented this stance to CMS at a meeting on January 30, 2013. Unfortunately, CMS concluded that there was insufficient evidence to warrant coverage of brain amyloid imaging.

But the fight isn’t over – it never is when the Alzheimer’s Association is involved. I expect the organization to continue fighting for this issue in the evidence-based, effective manner it always exemplifies. I applaud the Alzheimer’s Association and SNMMI for their hard work on this important development.

To learn more about brain amyloid imaging and the guidelines, click here and here. Perhaps you’ll even decide to get involved and advocate for coverage of this valuable procedure.

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