Rachel Pierce

November 9, 2015
RC 2001
Major Issues Essay
Pre-screening for Alzheimers Disease
Alzheimers disease is a degenerative brain disease that as of
right now is incurable. It is the most common type of dementia, and
early symptoms include difficulty remembering recent conversations,
names and events, and sometimes depression. Later symptoms
include things like impaired communication, disorientation, poor
judgment, confusion, behavior changes, and eventually, difficulty
speaking, walking and swallowing. Although research has revealed a
great deal about Alzheimers, much is yet to be discovered about the
precise biologic changes that cause Alzheimers, why it progresses
more quickly in some than in others, and how the disease can be
prevented, slowed or stopped. (2015 Alzheimers Disease Facts and
Figures) However, researchers believe that early detection will be
crucial to prevention and slowing of the disease. Research on early
detection has grown significantly in the last ten years. Before, the
criteria fro testing was evident signs of memory loss; but now that
more is known about how the disease can occur years before the
symptoms begin to show, the new proposed criteria for testing will
accommodate that fact.

Millions of Americans have Alzheimers disease and other dementias.

The number of Americans with Alzheimers disease and other
dementias will grow each year as the size and proportion of the U.S.
population age 65 and older continue to increase. The number will
escalate rapidly in coming years as the baby boom generation ages.
(2015 Alzheimers Disease Facts and Figures) This is a growing
problem, and according to tests and studies conducted by the
Alzheimers Association, about half of the estimated 5 million
Americans with Alzheimers were probably not told they have it by a
physician.
The latest advance in Alzheimer's diagnosis came this year,
when the U.S. Food and Drug Administration gave its approval to a
radioactive dye that can be used to determine whether the protein of
Alzheimer's disease is accumulating in the brain, says Dr. Jeffrey
Cummings, a neurologist and researcher and director of the Cleveland
Clinic Lou Ruvo Center for Brain Health. (reviewjournal.com) The
radioactive dye binds to amyloid plaque that accumulates in the brain
of a person with Alzheimer's. Then, a PET scan is conducted, and the
presence, or absence, of the plaque is revealed. (reviewjournal.com)
With these new tests, clinical trials can begin using a person who is not
showing symptoms in their daily lives yet, but their brain scans show
that there are already abnormalities presenting; this would allow
access to very early stages of the disease, and new research and

information. And if no amyloid plaque is found, that can rule out

Alzheimers, which will allow further testing for a different dementiarelated disease. This is important because with other certain types of
dementia, Alzheimers medications actually worsen the conditions. "So
it's the interaction between what the scan tells us and the clinical
examination. That's why the doctor is still important here," Cummings
continues. "And that, of course, is why we have to teach the medical
community how to use this scan, because you could easily get a
positive scan and say, 'You have Alzheimer's disease,' and we don't
think that. We think there's a lot of uncertainty in what's going to
happen to that person." (reviewjournal.com) That is why it is important
that primary care doctors are better educated on the exact signs of
Alzheimers, not just dementia in general.
Another important advance in early detection research is use of
biomarkers. A biomarker is something that can be measured to
accurately and reliably indicate the presence of disease. An example of
a biomarker is fasting blood glucose (blood sugar) level, which
indicates the presence of diabetes if it is 126 mg/dL or higher.
(Alzheimers and Dementia Testing for Earlier Diagnosis) There are
several different potential biomarkers that are being studied for their
ability to indicate the early symptoms of the disease. Some of these
include beta-amyloid and tau level in cerebrospinal fluid and brain
changes, which are detectable by different types of imaging. Beta

amyloid plaques are formed when protein pieces clump together. It is a

sticky substance that gradually builds up in the brain and can be very
damaging by blocking cell-to-cell signaling. The tau protein tangles up
inside the brain and destroys cell transports made of proteins. The tau
is normally there to keep the protein straight like tracks, for food and
other important molecules to travel on. However, when it begins to
twist and collapse it forms tangles, which cause the tracks to become
weak and disintegrate; therefore inhibiting food and nutrients from
traveling through cells, causing them to eventually die.
(alz.org/braintour)
However, researchers are strongly recommending patients who
do not show any symptoms to not get screened, because if they have
no symptoms they cannot be treated for anything. "At this point, we
don't have any medicine we know of to take in advance to prevent the
disease,""I would not recommend getting a test just to know."
(reviewjournal.com) Getting a test just for curiositys sake could be
extremely expensive. For some people, however, who know they have
a family history of the disease, knowing ahead of time could be very
beneficial in the long run. For example, knowing it might be a part of
your future would allow you to be prepared to seek treatments as soon
as you do recognize that you are showing symptoms, as well as have a
plan in place for at home care, or clinical care for when the time
comes. On the negative side, however, getting screened ahead of time

and being labeled as someone who might possibly develop the disease
could be detrimental to a career or other opportunities. For example,
an employer might be less willing to hire someone and provide them
with insurance benefits if they know he or she is more likely to develop
a life threatening disease within the next ten years or so. Other
complications have also come about; such as the fact that the test
costs about $4,400, which would not be covered by medical insurance
or Medicare.

"A big problem in Alzheimer's disease and research is that we're not
catching people early enough," Scharre says. "There are hundreds of
thousands of people out there that have symptoms.
(reviewjournal.com) [Not sure where to put this yet]

http://www.reviewjournal.com/life/health/tough-tests-why-getscreened-alzheimers-when-there-no-cure
11.2.15
https://www.alz.org/facts/downloads/facts_figures_2015.pdf 11.2.15
http://www.alz.org/research/science/earlier_alzheimers_diagnosis.asp
11.9.15
https://www.alz.org/braintour/tangles.asp 11.9.15