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Alzheimer’s debate: Test if you can’t treat it?
Question of the Day
“I’m certainly in the camp that screening should be done,” he said. Many patients are simply declared to have dementia without testing to see if they have another condition.
“Sometimes it’s thyroid disease, or depression, or vitamin B-12 deficiency _ something that’s very treatable,” he said.
Testing someone with symptoms is far less controversial than testing people with no symptoms but a lot of fear. Doctors worry that these newer methods, such as an easier type of brain scan that’s expected to be available within months, will be directly marketed to the public, prompting expensive and excessive testing based on fear.
“The phrase you often hear is that the ‘Big A’ (Alzheimer’s) has replaced the ‘Big C’ (cancer)” as a major source of fear, said Dr. Jason Karlawish, a University of Pennsylvania ethicist specializing in dementia issues.
Recent guidelines by the U.S. National Institute on Aging and the Alzheimer's Association say these tests should be used only in research until they have been standardized and validated as useful and accurate tools.
A researcher using one of these tests, such as a spinal fluid check for a substance that may predict Alzheimer’s risk, has no obligation to disclose the results to a patient until there is a meaningful treatment for the disease, Karlawish argued at the conference.
The more symptoms a patient has, the more justified it is to help understand what is known about possible reasons, he said.
Lynda Hogg of Edinburgh, Scotland, is very glad her doctors diagnosed her Alzheimer’s in 2006. She is doing exceptionally well on one of the existing drugs and is in a clinical trial for an experimental one she hopes will help her and help advance knowledge in the field.
At a discussion connected with the conference, she said the early diagnosis helped her get financial and legal matters in order and serve on the Scottish Dementia Working Group and the board of Alzheimer's Disease International.
“I am certain involvement keeps me focused and involved in society,” she said.
The Alzheimer's Association says early diagnosis and evaluation can bring the following benefits:
_ Treatment of reversible causes of impairment.
_ Access to drugs that help treat symptoms.
_ Inclusion in clinical trials that give expert care.
_ Avoiding drugs that can worsen cognition.
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