Is earlier diagnosis of Alzheimer’s around the corner?

By Patti Singer

The two most feared words in the English language arguably could be “Alzheimer’s disease.”

“People are still incredibly afraid of it,” said Dr. Allan Levey, chairman of the Department of Neurology at Emory University School of Medicine, during the Health Journalism 2012 session about potential ways to identify changes in the brain before symptoms of the dementia become obvious

Neil Buckholtz, chief of the Dementias of Aging Branch at the National Institute on Aging, and Dr. William Hu, assistant professor in the Department of Neurology at Emory University School of Medicine, also addressed the question, “Is earlier diagnosis of Alzheimer’s around the corner?”

Through the use of imaging technology and study of spinal fluid, changes that may lead to Alzheimer’s can be detected before symptoms arise. “We can diagnosis as accurately as autopsy now,” Hu said.

Right now, there is no cure and no long-term treatments that can arrest or reverse the decline. Still, the effort to identify people at risk of Alzheimer’s or with the disease is because “we’re all very clearly aware that our chances of making an impact with treatment will depend on making a diagnosis as early as possible,” Levey said.

Buckholtz provided an overview of the Alzheimer’s Disease Neuroimaging Initiative. The public-private partnership, managed through the Foundation for the National Institutes of Health, is designed to chart the progression of the disease. Studies are being conducted at 57 sites in the United States and Canada and participants are being followed for several years.

Research is scrutinizing the role of amyloid, identified by Dr. Alois Alzheimer. His drawings 100 years ago of those plaques and the tangles that are the hallmarks of the disease could have been made from pictures captured by modern imaging technology.

Buckholtz said that even people with normal cognition can show a significant amount of amyloid. “What does this mean? Does it put people at high risk of progression? We don’t know at this point.”

Hu said that researchers are starting to ask if Alzheimer’s is present before someone is cognitively impaired. The question is fueled by tests of spinal fluid and magnetic resonance imaging to detect abnormalities before there are outward signs.

He cautioned against getting too excited about use of blood biomarkers to assess risk or make an early diagnosis. While blood tests would be easy to use and quickly generate data, they lead to many discrepancies and results so far have been difficult to replicate.

Levey, who also is director of the Center for Neurodegenerative Disease and Alzheimer’s Disease Center at Emory University, said that Alzheimer’s is a mix of genetic and environmental factors. But that’s not to say choices will actually trigger the disease.

However, researchers in cardiovascular diseases are finding that what is good for the heart is good for the brain. Keeping blood pressure and cholesterol under control have no risk and tremendous benefits. Even though people are frightened at the prospect of losing themselves to Alzheimer’s, lifestyle changes in middle age or earlier seem to be a tougher sell against Alzheimer’s than it has been with obesity, diabetes and other conditions.

“Unlike heart disease and cancer, where there are survivors who can tell us compelling stories about why it’s so important to do things preventively,” he said, “we don’t have that yet.”

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Patti Singer is a health reporter at the Democrat and Chronicle in Rochester, N.Y.