A Test for Alzheimer’s?

There is great excitement in the Alzheimer’s world that a new test can predict if a person will have the disease with 100% certainty. This according to a study published in the Archives of Neurology .

Simply put, the study looked for indications of Alzheimer’s in spinal fluid taken from a group of 300 individuals all over 70 years of age. 114 had normal memories, online 200 had memory problems and 102 actually already had Alzheimer’s disease. It was blind study where individuals and researchers did not know the status of the subjects.

The New York Times summarized the results:

Nearly every person with Alzheimer’s had the characteristic spinal fluid protein levels. Nearly three quarters of people with mild cognitive impairment, a memory impediment that can precede Alzheimer’s, had Alzheimer’s-like spinal fluid proteins. And every one of those s with the proteins developed Alzheimer’s within five years. And about a third of people with normal memories had spinal fluid indicating Alzheimer’s. Researchers suspect that those people will develop memory problems.

From CBS News

The study, conducted by Dr. Geert De Meyer of Ghent University in Belgium, showed that the three biomarkers – known as CSFamyloid beta 1-42, total CSF tau protein and P-Tau181P – were present in more than 90 percent of s who went on to develop Alzheimer’s disease.

“This is what everyone is looking for, the bull’s-eye of perfect predictive accuracy,” Dr. Steven DeKosky, dean of the University of Virginia medical school, who is not connected to the new research, told the New York Times about the spinal tap study.

A lot of work has to be done before the spinal tap test is widely offered to s.

“To date, cerebrospinal fluid analyses have not been a routine component of assessment and care for s with cognitive impairments and suspected Alzheimer’s disease in the United States,” Dr. A. Zara Herskovits, of Brigham and Women’s Hospital, and Dr. John H. Growdon, of Massachusetts General Hospital, wrote in an editorial that accompanied the study. “There is now ample evidence that these measurements have value; physicians need to formulate when and how to incorporate cerebrospinal fluid measurements into their practice.”

With this good news comes a warning for more work to standardize tests and to set expectations that this is not a cure. From the New York Times

Already, some doctors are using biomarkers, like spinal fluid tests that are commercially available, against the advice of researchers. Scientists are still working on standardizing the tests — making sure that, like a test for cholesterol or cancer, an Alzheimer’s biomarker test done in one lab will give the same results as one done elsewhere. The spinal fluid tests can show levels of amyloid and another Alzheimer’s protein, tau. But it is not yet known what levels of amyloid or tau in spinal fluid are abnormal. And measurements of amyloid and tau can vary as much as 30 percent from one research lab to another, said Dr. Marilyn Albert of Johns Hopkins University. “That’s why we are very concerned about these measurements being used in al settings at the current time.”

The investigators said people worried about their memory should consider entering al trials studying the natural history of the disease and testing new drugs. It might be a decade or more before any drugs are found to work and approved for marketing. So there is not much people can do if they go to a private doctor, have a spinal fluid test and are told they might be in the early stages of Alzheimer’s. The test might not be valid, and no drugs now on the market can slow the disease.

The Alzheimer’s Association recently established a website for individuals wanting to join a al trail called TrailMatch.

On a personal note, what if this new test had been available the moment our family recognized my Mom had memory problems? Would we had chalked her occasional misstatement to normal aging, or to dementia or even guessed it was Alzheimer’s? Would we have put her through a spinal tap which can be difficult for many people?

In perfect hindsight, my answer is yes. I am not sure how the rest of my family would have voted or what my Mom would have said. My rational is that if we knew her disease was so serious, we would have accelerated putting her on one of the few drugs that seem to symptoms. We would have pressed even harder (if possible) on our Dad to move into some type of assisted living. That said, we pushed so hard at the time that it put strains on the family.

Would all this had made a difference? That I will never know but it would have been nice to have a choice.

Remember: Memories are Everything.

Alan

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8 thoughts on “A Test for Alzheimer’s?

  1. My understanding from the report is that if one knows early on (spinal test), there are things one can do (currently available drugs & lifestyle changes) to slow the progression of the proteins and plaques. In that case I would want to know ASAP.

  2. You’re right Shanda, you can’t stop the disease (today) however you can help with quality of life and help everyone around that individual get through a very difficult period. Often this disease is confused with aging or other problems thus not talking advantage of available resources or tools to make life easier.

  3. Understand Pam. The problem often is that the issue is obvious to everyone except to that person. I remember we worked with the VA to have Dad’s drivers license revoked. It was very difficult for everyone but the right thing to do.

  4. Yes, some time ago, I was telling my father-in-law about a class I was taking on parenting your parents. I said that it would be hard to determine when the appropriate time would be for the adult child to step in and make some tough decisions–like not driving the car, etc. My fa.-in-law’s response: NEVER

  5. Pam, one of my fond saying is that is is OK to forget where you put your car keys but not OK to forget you have a car. There are other simple tests that can help diagnose aging vs dementia other than the spinal fluid one in this article.

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