Combining a Brain Scan with a Spinal Fluid Test

Contributed by: Dennis Fortier, President, Medical Care Corporation
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According to a study published in the latest issue of Archives of Neurology, researchers at University College London's Institute of Neurology have collected evidence of a correlation between two interesting brain pathologies. The research looked at low levels of beta-amyloid in the spinal fluid and, based on an MRI brain scan twelve months later, the rate of brain atrophy (or shrinkage).

The interest in this study stems from prior research showing that a low level of amyloid in the cerebral spinal fluid (CSF) is a common (but not certain) precursor to Alzheimer's disease. Furthermore, typical Alzheimer's pathology includes the death of brain cells leading to brain shrinkage. Therefore, noting that these two indicators seem to move in unfavorable directions, even before symptoms are present, might lead to methods for earlier detection and intervention.

In general, the expert research community supports the notion of combining indicators to detect early trends that should be carefully monitored. While this study is certainly noteworthy, coverage in the media, that has portrayed these findings as a method for detecting early stage Alzheimer's disease, is probably over-stated at this early point.
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Does Early Diagnosis of Alzheimer's Really Create an Ethical Dilemma?

Contributed by: Dennis Fortier, President, Medical Care Corporation
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Does early diagnosis of Alzheimer's really create an ethical dilemma?

For all of the press devoted to scrutinizing the pros and cons of delivering an Alzheimer's diagnosis to a patient with only mild symptoms, including a front page article in today's NY Times, it is easy to overlook the question posed above. In fact, anyone could be forgiven if they assumed, based on the constant characterization in the press, that a dilemma is at hand.

The Dilemma That Isn't
Posing this question may generate provocative headlines and robust debate but, if we step back and consider the larger context, there really is no dilemma. We do not need any ethicists to ponder and rule on this question because it doesn't require a single, universal answer.

Some people seek clinical information and get comfort from having it available, even when the information consists of bad news like an Alzheimer's diagnosis. Others prefer ignorance when new information will cause them to worry needlessly about a situation they cannot change.

Patients Choose
Rather than debating which approach is better and pronouncing the presence of a dilemma, all we need to do is let individuals choose their preference. Those who want to know should be told; those who do not want to know, needn't have the information thrust upon them. When someone has a sign or symptom of a medical problem and then seeks a physician's opinion about the underlying problem, they are pretty much declaring that they want a diagnosis. In the real world, the "want-to-know vs. don't-want-to-know" decision is made by either consulting a physician or not.

This situation is not as black and white as described here, but it certainly is far less gray than characterized by the press. In general, people seeking medical attention for a cognitive complaint want help and physicians have an obligation to diagnose the problem and treat it as effectively as possible.

Sometimes this will involve giving patients news they would rather not hear, but the symptoms and the angst that comes with those symptoms, are already a reality in the patient's lives. A definitive diagnosis reduces uncertainty and helps the treatment process move optimally forward.

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A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share button below to spread this educational message as widely as possible.

Could Alzheimer's be Caused by Inflammation?

Contributed by: Dennis Fortier, President, Medical Care Corporation
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As with all unsolved scientific problems, hypotheses are constantly developed, modified, and tested with each new study shaping the ongoing debate in some way. In terms of the question "What Causes Alzheimer's?", the hypothesis that inflammation is the culprit has long been discussed and, to some degree, tested in the lab.

The LA Times ran an interesting article this week highlighting the inflammation hypothesis and describing its merits. It's a good overview of a theory that is not considered central by leading thinkers today, but may well have merit.

One quote in the article suggests that this is a "very new" way of thinking about the problem, but that is not really true. Inflammation has been fairly well scrutinized for its role in the Alzheimer's disease process. The current scientific emphasis elsewhere (primarily on the amyloid hypothesis), merely suggests that inflammation is not the most compelling avenue according to most of the experts in the field.

However, most would agree that inflammation may play some role in the complex cascade of pathology associated with this disease.
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A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.