Skip to main content

The new brain scan for Alzheimer's: what's early certainty worth?


Last week the NY Times story on a new scan that identifies Alzheimer's in the brain caught my eye, and probably caught yours too. What is the benefit of this test, wondered my colleague Alex Smith in a recent Geripal post, and is it worth the cost?

What is the value of "knowing for sure -- period"?

I can't say I know the answer for sure, but I do know that the period of uncertainty is hard on most families when we work up early cognitive impairment in the outpatient setting. (It usually lasts for months, if not longer.)

I also know that for geriatricians in outpatient clinical practice, the diagnostic question isn't just "Is it or isn't it Alzheimer's?" It's also:

  • What's causing this cognitive impairment? 
  • Is it dementia (of any stripe)?
  • Are there any additional factors making the cognition worse? (As in: medications, medications, and oh yes, medications. Benzos and anticholinergics, I'm talking about you.)

The new brain scan, obviously, doesn't answer many of these questions, nor does it directly lead to better dementia care for patients and families. 

Still, I think that decreased period of uncertainty might be valuable, especially when I think about how the process of diagnosing early dementia usually goes. (I wrote about my experience of this process in more detail on the Geritech.org blog this week.)

So although usually I'm a less-is-more kind of clinician, I find myself conflicted about the scan.

Would I order it? Maybe. 

What about the rest of you? I'm especially eager to hear thoughts from the other clincians who are diagnosing dementia in the outpatient setting. 



by: Leslie Kernisan

Comments

Popular posts from this blog

Lost in Translation: Google’s Translation of Palliative Care to ‘Do-Nothing Care’

by: Cynthia X. Pan, MD, FACP, AGSF (@Cxpan5X)

My colleagues often ask me: “Why are Chinese patients so resistant to hospice and palliative care?” “Why are they so unrealistic?” “Don’t they understand that death is part of life?” “Is it true that with Chinese patients you cannot discuss advance directives?”

As a Chinese speaking geriatrician and palliative care physician practicing in Flushing, NY, I have cared for countless Chinese patients with serious illnesses or at end of life.  Invariably, when Chinese patients or families see me, they ask me if I speak Chinese. When I reply “I do” in Mandarin, the relief and instant trust I see on their faces make my day meaningful and worthwhile.

At my hospital, the patient population is about 30% Asian, with the majority of these being Chinese. Most of these patients require language interpretation.  It becomes an interesting challenge and opportunity, as we often need to discuss advance directives, goals of care, and end of life care options…

Elderhood: Podcast with Louise Aronson

In this week's podcast we talk with Louise Aronson MD, MFA, Professor of Geriatrics at UCSF about her new book Elderhood, available for purchase now for delivery on the release date June 11th.

We are one of the first to interview Louise, as she has interviews scheduled with other lesser media outlets to follow (CBS This Morning and Fresh Air with Terry...somebody).

This book is tremendously rich, covering a history of aging/geriatrics, Louise's own journey as a geriatrician facing burnout, aging and death of family of Louise's members, insightful stories of patients, and more.

We focus therefore on the 3 main things we think our listeners and readers will be interested in.

First - why the word "Elder" and "Elderhood" when JAGS/AGS and others recently decided that the preferred terminology was "older adult"?

Second - Robert Butler coined the term ageism in 1969 - where do we see ageism in contemporary writing/thinking?  We focus on Louise's…

Psychedelics: Podcast with Ira Byock

In this week's podcast, we talk with Dr. Ira Byock, a leading palliative care physician, author, and public advocate for improving care through the end of life.

Ira Byock wrote a provocative and compelling paper in the Journal of Pain and Symptom Management titled, "Taking Psychedelics Seriously."

In this podcast we challenge Ira Byock about the use of psychedelics for patients with serious and life-limiting illness.   Guest host Josh Biddle (UCSF Palliative care fellow) asks, "Should clinicians who prescribe psychedelics try them first to understand what their patient's are going through?" The answer is "yes" -- read or listen on for more!

While you're reading, I'll just go over and lick this toad.

-@AlexSmithMD





You can also find us on Youtube!



Listen to GeriPal Podcasts on:
iTunes Google Play MusicSoundcloudStitcher
Transcript
Eric: Welcome to the GeriPal Podcast. This is Eric Widera.

Alex: This is Alex Smith.

Eric: Alex, I spy someone in our …