Debate Over Brain Scans and Alzheimer’s

February 19, 2013 at 7:14 pm Leave a comment

Alzheimer’s is a very common disease among most of our clients here at AmeriCare Georgia. Should brain scans for our aging loved ones with suspected Alzheimer’s be covered by Medicare? We found an informative article from New York Times that gives great insight from both viewpoints on this recent debate.

An expert panel convened by the Centers for Medicare and Medicaid Services concluded that data supporting use of the scans was weak. This controversy deserves attention because these scans are rapidly becoming available across the country, along with proposed guidelines for use from the Alzheimer’s Association and the Society of Nuclear Medicine and Molecular Imaging.

These tests cost about $3,000- an amount that puts most families out of reach. Currently, Medicare does not pay for these tests, but the government later this year will use expert panel findings to determine whether or not this policy needs to be changed.

So, how useful is this information?  Many pro-Medicare coverage standpoints suggest that these image tests could help physicians diagnose Alzheimer’s or other types of dementia at an early stage. Many neurologists such as Stephen Salloway at Warren Alpert Medical School at Brown University raise questions such as, “Should I tell my patients that we have a test available to help clarify their diagnosis but we can’t use it because Medicare doesn’t cover it?”

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The scans definitely help identify which disease people may be, or have the potential to, suffer from. If scans show lack of amyloid plaques, distinct characteristics of Alzheimer’s, doctors can rule out Alzheimer’s and pursue other lines of medical inquiry. If tests come back positive, doctors would be able to rule out conditions like frontotemporal dementia and motivate patients to start being active about Alzheimer’s prevention.

On the other hand, although Alzheimer’s is linked to amyloid plaques, the roles have not yet been definitively established. They could easily serve a function not yet discovered or understood. Research finds about 30 percent of older adults with no symptoms of dementia have been found to have amyloid plaque buildup in their brains.

“I see a big potential for overuse and misuse,” warned Dr. Raymond Faught, Jr., a member of the Medicare advisory panel and a professor of neurology at Emory University in Atlanta.

The Alzheimer’s Association and the Society of Nuclear Medicine and Molecular Imaging tried to address this controversy in their latest stated guidelines. These guidelines suggest that scans should be considered for patients with Alzheimer’s type symptoms but “an unclear clinical presentation”; those who develop dementia symptoms before the age of 65; and those with “persistent” mild cognitive impairment.

Tests should not be given to normal patients or those who have already been diagnosed with Alzheimer’s, the guidelines continue to state.

Chairwoman of the Medicare Evidence Development and Coverage Advisory Committee Rita Redberg states, “We were there to evaluate the impact of this test on patient outcomes. But all of the speakers said there wasn’t any data linking amyloid scans to outcomes… They presented evidence that the test is very good at identifying amyloid, but they did not present evidence that it was very good at identifying the clinical presence of Alzheimer’s disease.”

What do you think, readers? Should Medicare cover these tests? Do you think your aging loved ones who show possible Alzheimer’s symptoms would benefit from knowing definitively that they do, or don’t have Alzheimer’s?

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