next week i will be giving a presentation to about 50 premed students at the local university here
as i was reviewing my slides i thought about my slide for the adni 2 study i was in for five years
looking at this slide i realized it tied into the article i read about another study called the ideas study
on this slide
the adni study 2
good history and physical
labs
neuropsychological exam and memory tests
mri of the brain
these above insurance pays for in the evaluation of memory loss
these below insurance will not pay for in the evaluation of memory loss
genetic test apoe 4 test
spinal fluid analysis for amyloid and tau
amyvid pet scan
this is what i will telling these future doctors
to start a work up for memory loss you start with something thats been around for decades
a good history and physical
listening to the patient and examining the patient
pretty simple huh
is it a lost art
maybe
when you finish listening to the patient and examining the patient you usually know whats wrong with them
next if indicated
you check some labs for memory loss
a complete blood count a chemistry profile looking at the electrolytes and liver functions and kidney functions and blood sugars a tsh which tests for low thyroid or hypothyroidism a vitamin b12 level
these can affect memory
next if indicated
you do a in office memory test like the moca test
if its negative then the memory is probably ok
if its positive then proceed to a neuropsychological test which is the gold standard memory test
next if indicated
you do a mri
it will rule out masses tumors increased fluid old or new strokes brain shrinkage etc
usually at this point you can diagnose most patients
maybe a person has low thyroid or low vitamin b12 or sleep apnea or depression or anxiety or is on drugs that can cause memory loss or have alcohol or drug abuse or have poorly controlled blood pressure or diabetes
you try to fix those first before you go further or start memory loss meds
correcting these things sometimes corrects memory loss
then
in 2019 if you want to really know for as sure as you can that you have alzheimers disease and you are willing to spend the money like i did
then you can find out for sure with a high degree of accuracy
first
do genetic tests for early onset alzheimers which represents <1% of the cases of alzheimers disease
if you have one of these genes well you will get alzheimers disease
do the genetic test for apoe 4 gene or whats called the late onset alzheimers gene
you can get a single apoe 4 gene or a double apoe 4 gene or if you are lucky youll get the better ones apoe 2 or apoe 3 which carries less risk
we all have a combo of one of these
having a single apoe 4 which 25% of us have gives us a 5x increased risk
having a double apoe 4 gene which less than 3% of us have gives a 10-25x increased risk of getting alzheimers
unlike the early onset gene this apoe 4 gene doesnt mean you will definitely get alzheimers it means you are at an increased risk of getting this
of course
if
you have this apoe 4 gene on your record and try to get life insurance or long term insurance or disability insurance or if they change the preexisting condition on health insurance
well you wont be able to get get any of these insurances or if you do your rates will be real real high
how healthy you live your life determines how this apoe 4 gene will affect you
spinal fluid analysis for amyloid and tau
in alzheimers
amyloid gets deposited in the brain early on then a few years later tau tangles show up in the brain
both cause the destruction you see in alzheimers disease
they both have normal levels in the spinal fluid
as alzheimers disease advances these values become abnormal
this test is one of the biomarkers for alzheimers
the amyvid pet scan uses a radioactive compound given in an iv which then binds to the amyloid in the brain
this amyloid the hallmark of alzheimers disease get highlighted in the brain
if you have alzheimers this test will be positive
this test is one of the biomarkers for alzheimers
so if you do all these covered by insurance tests and all the uncovered by insurance tests then you will know with a high degree of certainty if you have alzheimers
close i would say to 100% certainty
the cost can be as much as $15,000 unless of course you do some of them in a research study
eg i found out my amyvid pet scan was positive by enrolling in the aducanumab study
if its negative they woudnt take you
if its positive then they would take you
now enter the ideas study
they took folks who specialists felt might benefit from the amyvid pet scan in getting a more accurate diagnosis
then
they evaluated did it make much difference really knowing for sure
the center for medicare is trying to determine if they should be paying for these scans
does it really make a difference since there is no known treatment
in this ideas study
61% had their diagnosis changed
10% who were diagnosed with not having alzheimers disease had a positive scan ie they had alzheimers disease
about 25% who were diagnosed with alzheimers disease had a negative scan ie they did not have alzheimers disease
but
does this make a difference
well not in the end since most with alzheimers will die from the alzheimers disease
what about those who thought they had it but didnt
i think it does make a difference
as someone who went through all this i definitely am glad i know
i know what i have
i also know what to expect
it has greatly helped myself and my wife she and our family for accepting and getting ready for the future
it has allowed me to be in research studies
it has made me alter my healthy living
something i have done and am doing seems to have slowed this down some
if i didnt know all these results i probably would not be doing as well as i am
sometimes i sit and hold mr h knowing as i look into the future that i have limited time here
how much i have no idea
but i want to extract as much as i can while i can
i know that any day that drop off off that cliff could start
i guess we all should approach life that way
huh
the organicgreen doctor
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