As I read through Wayne Winegarden's "Treating Alzheimer's with regulations" (Commentary, May 7), I was overcome by many of the statistics surrounding the neurodegenerative disorder. It is clear that Alzheimer's disease is becoming as expansive as it is expensive, but I found myself asking if Medicare is neglectful of rising costs associated with the disease, or if it is wary of the nascent applications of nuclear medicine.
The emerging use of Positron Emission Tomography (PET) scans to detect neurological degeneration has a great deal of potential. More exciting is the ability to use molecular tracers to detect beta amyloid plaques, depositions of cellular proteins that are strongly correlated with Alzheimer's progression.
However, there are several questions surrounding PET scans that keep amyloid beta plaques from being routinely indicated. Beta amyloid deposition and neurodegeneration have been shown to precede symptoms of Alzheimer's by 20 to 30 years. So when is it appropriate to start screening? At the start of symptoms? Thirty years before the average age of onset? How reliable is the test for distinguishing beta amyloid Alzheimer's from other forms of dementia, or even from the normal aging process?
Currently, the standard of care hasn't been established. It is for this reason that most private insurance companies, in addition to Medicare, do not consider PET scans to be worth their price tag of several thousand dollars, nor do they consider them to be clinically indicated in Alzheimer's (Aetna, CIGNA and others consider PET scans for Alzheimer's "experimental, investigational or unproven").
Perhaps government intervention isn't an answer in many ways, but it has been on the cutting edge of diagnostic and imaging research in Alzheimer's. The National Institute of Neurological Disorders and Stroke, as well as the National Institute of Biomedical Imaging and Bioengineering, have started several projects in an effort to learn more about Alzheimer's. The Obama administration has even increased clinical trial funding for diagnostics and treatment as part of its "National Plan to Address Alzheimer's Disease" by 2025.
Mr. Winegarden makes an excellent point that these tests need to be explored further. They need research and standardization so such an expensive test isn't used unless absolutely necessary. I think he will agree that means a shifting of support to the right areas of research and health care.
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