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One in three children with MS has cognitive impairment

admin — Wed, 06 Feb 2013 21:02:24 +0000

One in three children with MS has cognitive impairment : Human Health & Science

Feb. 5, 2013 Data from the largest multicenter study accessing cognitive functioning in children with multiple sclerosis (MS) reveals that one-third of these patients have cognitive impairment, according to a research paper published in the Journal of Child Neurology. Led by Lauren B. Krupp, MD, Director of the Lourie Center for Pediatric Multiple Sclerosis at Stony Brook Long Island Children’s Hospital, the study indicates that patients experience a range of problems related to cognition.

In “Cognitive Impairment Occurs in Children and Adolescents with Multiple Sclerosis: Results from a United States Network,” Dr. Krupp and colleagues from Stony Brook and five other national Pediatric MS Centers of Excellence measured the cognitive functioning of 187 children and adolescents with MS, and 44 who experienced their first neurologic episode (clinically isolated syndrome) indicative of MS. They found that 35 percent of the patients with MS and 18 percent of those with clinically isolated syndrome met criteria for cognitive impairment. All patients were under age 18 with an average disease duration of about two years.

“This study is important because it represents the largest study to date to apply a comprehensive neuropsychological battery of tests to evaluate the cognitive functioning of children with MS, and the results clearly show us that cognitive issues are widespread and can occur early on in the disease course of these patients,” said Dr. Krupp, also a Professor of Neurology at Stony Brook University School of Medicine. “These are critically important findings that emphasize the need for prompt recognition of our patients’ cognitive problems and for neurologists and other MS specialists to discover ways to intervene and help improve the cognitive abilities of these children while they are in school and beyond.”

The authors report that the network of Pediatric MS Centers of Excellence used a comprehensive battery of 11 tests where the scores addressed cognitive domains such as general ability, reading and language, attention, working memory and speed processing, executive functioning, verbal learning and recall, visual-motor integration, and fine motor speed and coordination. The testing took approximately 2.5 hours to complete, and a participant was considered impaired when the proportion of impaired scores from the categorized tests was greater than one-third.

They found that the most frequent areas of impairment were fine motor coordination (54 percent), visual-motor integration (50 percent), and speeded information processing (35 percent). Among the various tests that showed the most frequent rate of impairment were the grooved peg board, a measure of fine motor speed and coordination, and a test for visual-motor integration, a measure that is dependent in part on fine motor coordination.

The researchers factored in clinical variables in the analysis, including disease duration, diagnosis status, age of disease onset, and disability. They found that a diagnosis of MS and overall neurologic disability were the only two independent predictors of cognitive impairment.

They also factored in sociodemographic variables such as age, gender and ethnicity, and leveraged the geographic diversity of the Pediatric Multiple Sclerosis Centers of Excellence network to create the sample. Centers participating in the study included: the Lourie Center for Pediatric Multiple Sclerosis at Stony Brook; the University of California, San Francisco; University of Alabama, Birmingham; the Jacobs Neurological Institute, SUNY Buffalo; Massachusetts General Hospital in Boston, and the Mayo Clinic in Rochester, Minn.

The authors point out that the next step for pediatric MS investigators within the network is to further the research “to develop strategies for prompt identification of children with multiple sclerosis at risk for cognitive problems so that treatment can be initiated.”

The study was supported in part by the National Multiple Sclerosis Society.

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The above story is reprinted from materials provided by Stony Brook Medicine.

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Journal Reference:

L. Julian, D. Serafin, L. Charvet, J. Ackerson, R. Benedict, E. Braaten, T. Brown, E. O’Donnell, J. Parrish, T. Preston, M. Zaccariello, A. Belman, T. Chitnis, M. Gorman, J. Ness, M. Patterson, M. Rodriguez, E. Waubant, B. Weinstock-Guttman, A. Yeh, L. B. Krupp. Cognitive Impairment Occurs in Children and Adolescents With Multiple Sclerosis: Results From a United States Network. Journal of Child Neurology, 2012; 28 (1): 102 DOI: 10.1177/0883073812464816

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New stroke gene discovery could lead to tailored treatments

Fri, 01 Feb 2013 16:18:27 +0000

New stroke gene discovery could lead to tailored treatments : Human Health & Science

Jan. 31, 2013 A study led by King’s College London has identified a new genetic variant associated with stroke. By exploring the genetic variants linked with blood clotting — a process that can lead to a stroke — scientists have discovered a gene which is associated with large vessel and cardioembolic stroke but has no connection to small vessel stroke.

Published in the journal Annals of Neurology, the study provides a potential new target for treatment and highlights genetic differences between different types of stroke, demonstrating the need for tailored treatments.

Approximately 152,000 people in Britain have a stroke each year, costing the UK over £8.2 billion. While there are thought to be 1.2 million stroke survivors in the UK, more than half have been left with disabilities that affect their daily lives.

A stroke occurs when the blood supply to the brain is cut off, often due to a blood clot blocking an artery that carries blood to the brain, which then leads to brain cell damage. Coagulation (blood clotting) abnormalities, particularly easy clotting of the blood, are therefore common contributing factors in the development of stroke.

Dr Frances Williams, Senior Lecturer from the Department of Twin Research and Genetic Epidemiology at King’s and lead author of the paper, said: ‘Previous studies have demonstrated the influence of genetic factors on the components of coagulation. The goal of this study was to extend these observations to determine if they were further associated with different types of stroke.’

The research was carried out in three stages. The first consisted of a genome-wide association study (GWAS) in 2100 healthy volunteers which identified 23 independent genetic variants that were involved in coagulation. The second stage examined the 23 variants in 4200 stroke and non-stroke cases from centres across Europe (Wellcome Trust Case Control Consortium 2 and MORGAM collections) and found that a particular mutation on the ABO gene was significantly associated with stroke.

Stage three of the study used the MetaStroke cohort, a project of the International Stroke Genetics Consortium which comprises 8900 stroke cases recruited from centres in the Europe, USA and Australia, whose DNA has been collected and undergone GWA scan. It was confirmed that a variant in the ABO blood type gene was associated with stroke, a finding specific to large vessel and cardioembolic stroke.

Dr Williams said: ‘The discovery of the association between this genetic variant and stroke identifies a new target for potential treatments, which could help to reduce the risk of stroke in the future. It is also significant that no association was found with small vessel disease, as this suggests that stroke subtypes involve different genetic mechanisms which emphasises the need for individualised treatment.’

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Exposure to antiepileptic drug in womb linked to autism risk

Thu, 31 Jan 2013 20:13:38 +0000

Exposure to antiepileptic drug in womb linked to autism risk : Human Health & Science

Jan. 30, 2013 Children whose mothers take the antiepileptic drug sodium valproate while pregnant are at significantly increased risk of autism and other neurodevelopmental disorders, suggests a small study published online in the Journal of Neurology Neurosurgery and Psychiatry.

The authors base their findings on children born to 528 pregnant women between 2000 and 2004 in the North West of England.

Just fewer than half the mums (243) had epilepsy, all but 34 of whom took antiepileptic drugs during their pregnancy. Fifty nine mums took carbamazepine; 59 took valproate; 36 took lamotrigine; 41 took a combination; and 15 took other drugs.

The children’s physical and intellectual development was assessed at the ages of 12 months, three and six years. Information was also obtained from their mothers about whether they had had to consult specialists about their child’s behaviour, development, educational progress or health.

Full data on all three assessments were available for 415 children. In all, 19 children had been diagnosed with a neurodevelopmental disorder by the time they were six years old, three of whom also had a physical abnormality.

Of these, 12 had a form of autism, one of whom was also diagnosed with attention deficit hyperactivity disorder (ADHD). Three had ADHD alone, while a further four had dyspraxia, a condition that results in poor physical coordination and excessive clumsiness.

Neurodevelopmental problems were significantly more common among those children whose mums had epilepsy — 7.46% compared with 1.87% of those whose mums did not have the condition.

And those children whose mums had taken valproate singly or in combination with other drugs while pregnant were significantly more likely to have been diagnosed with a neurodevelopmental condition than were those whose mums taking other drugs to treat their condition.

When all the figures were analysed and factors likely to influence the results accounted for, the findings showed that children exposed to valproate alone in the womb were six times more likely to be diagnosed with a neurodevelopmental disorder. Those exposed to valproate plus other drugs were 10 times more likely to do so than were children whose mums did not have the condition.

More than one in 10 (12%; 6 out of 50) children whose mums had taken valproate alone during their pregnancy had a neurodevelopmental problem, as did one in seven (15%; 3 out of 20) of those whose mums had taken valproate with other drugs.

No child born to a mum with epilepsy, but who didn’t take drugs for the condition during her pregnancy, was diagnosed with a neurodevelopmental disorder, although the numbers of women in this group were small, caution the authors.

Boys were three times more likely than girls to be diagnosed with a neurodevelopmental disorder, but no significant associations were found for the mother’s age or IQ, length of pregnancy, or epileptic seizure type.

The authors point out that other research has pointed to the potentially harmful effects of valproate on the developing fetus, and that the findings of the current study back other preliminary research. But further research would be needed before definitive conclusions could be reached, they caution.

“If sodium valproate is the treatment of choice, women should be provided with as much information as possible to enable them to make an informed decision,” and children whose mums took the drug during pregnancy should be monitored closely, write the authors.

“But on no account should pregnant women just stop taking the drug for fear of harming their developing child,” urge the authors.*

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The above story is reprinted from materials provided by BMJ-British Medical Journal.

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Journal Reference:

Rebecca Louise Bromley,
George E Mawer,
Maria Briggs,
Christopher Cheyne,
Jill Clayton-Smith,
Marta García-Fiñana,
Rachel Kneen,
Sam B Lucas,
Rebekah Shallcross,
Gus A Baker,
On Behalf of the Liverpool and Manchester Neurodevelopment Group. Research paper: The prevalence of neurodevelopmental disorders in children prenatally exposed to antiepileptic drugs. Journal of Neurology Neurosurgery and Psychiatry, 2013 DOI: 10.1136/jnnp-2012-304270

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Obesity may increase risk of multiple sclerosis in children and teens

Thu, 31 Jan 2013 06:53:27 +0000

Obesity may increase risk of multiple sclerosis in children and teens : Human Health & Science

Jan. 30, 2013 Being obese may increase the risk of developing multiple sclerosis (MS) in children and teenage girls, according to new research published in the January 30, 2013, online issue of Neurology®, the medical journal of the American Academy of Neurology.

“Over the last 30 years, childhood obesity has tripled,” said study author Annette Langer-Gould, MD, PhD, with the Kaiser Permanente Southern California Department of Research & Evaluation in Pasadena and a member of the American Academy of Neurology. “In our study, the risk of pediatric MS was highest among moderately and extremely obese teenage girls, suggesting that the rate of pediatric MS cases is likely to increase as the childhood obesity epidemic continues.”

For the study, researchers identified 75 children and adolescents diagnosed with pediatric MS between the ages of 2 and 18. Body mass index (BMI) from before symptoms appeared was obtained. The children with MS were compared to 913,097 children who did not have MS. All participants were grouped into weight classes of normal weight, overweight, moderate obesity and extreme obesity. A total of 50.6 percent of the children with MS were overweight or obese, compared to 36.6 percent of the children who did not have MS.

The study found that the risk of developing MS was more than one and a half times higher for overweight girls than girls who were not overweight, nearly 1.8 times higher in moderately obese girls compared to girls of normal weight and nearly four times higher in extremely obese girls. The same association was not found in boys.

“Even though pediatric MS remains rare, our study suggests that parents or caregivers of obese teenagers should pay attention to symptoms such as tingling and numbness or limb weakness, and bring them to a doctor’s attention,” said Langer-Gould.

The study was supported by the National Institute of Diabetes and Digestive and Kidney Disorders, and Kaiser Permanente Direct Community Benefit Funds.

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The above story is reprinted from materials provided by American Academy of Neurology (AAN), via Newswise.

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Obesity may increase risk of multiple sclerosis in children and teens

Thu, 31 Jan 2013 06:48:29 +0000

Obesity may increase risk of multiple sclerosis in children and teens : Human Health & Science

The study was supported by the National Institute of Diabetes and Digestive and Kidney Disorders, and Kaiser Permanente Direct Community Benefit Funds.

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The above story is reprinted from materials provided by American Academy of Neurology (AAN), via Newswise.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Whistle away the need for diapers: Vietnamese babies often out of diapers at nine months

Wed, 30 Jan 2013 16:18:30 +0000

Whistle away the need for diapers: Vietnamese babies often out of diapers at nine months : Human Health & Science

Jan. 30, 2013 Western babies are potty trained later these days and need diapers until an average of three years of age. But even infants can be potty trained. A study by researchers at Sahlgrenska Academy, University of Gothenburg, Sweden, followed 47 infants and their mothers in Vietnam — where potty training starts at birth and the need for diapers is usually eliminated by nine months of age.

Not only does eliminating the need for diapers save money and remove one practical chore for parents, but the baby’s ability to control its bladder improves efficiency and reduces the risk of urinary tract infection, researchers say.

International research shows that Western babies are being potty trained later these days and average 3-4 years of age before they can take care of their own toileting needs. The situation in Vietnam is very different.

Researchers at Sahlgrenska Academy, University of Gothenburg, followed 47 Vietnamese mothers for two years to study their potty training procedure, which begins at birth and generally eliminates the need for diapers by nine months of age. The technique is based on learning to be sensitive to when the baby needs to urinate.

“The woman then makes a special whistling sound to remind her baby,” Anna-Lena Hellström says. “The whistling method starts at birth and serves as an increasingly powerful means of communication as time goes on.”

According to the study, women notice signs of progress by time their babies are three months old. Most babies can use the potty on their own by nine months of age if they are reminded, and they can generally take care of all their toileting needs by the age of two.

“Our studies also found that Vietnamese babies empty their bladders more effectively,” Professor Hellström says. “Thus, the evidence is that potty training in itself and not age is the factor that causes bladder control to develop.”

Swedes have grown accustomed to the idea that babies cannot be potty trained, but that parents need to wait until they are mature, usually when they decide that they no longer want diapers. The evidence from Vietnam demonstrates that more sophisticated communication between parents and their babies would permit potty training to start and be completed much earlier.

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The above story is reprinted from materials provided by University of Gothenburg, via AlphaGalileo.

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Journal Reference:

Thi Hoa Duong, Ulla-Britt Jansson, Anna-Lena Hellström. Vietnamese mothers’ experiences with potty training procedure for children from birth to 2 years of age. Journal of Pediatric Urology, 2012; DOI: 10.1016/j.jpurol.2012.10.023

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Eating bright-colored fruits and vegetables may prevent or delay amyotrophic lateral sclerosis

Tue, 29 Jan 2013 15:38:45 +0000

Eating bright-colored fruits and vegetables may prevent or delay amyotrophic lateral sclerosis : Human Health & Science

Jan. 29, 2013 New research suggests that increased consumption of foods containing colorful carotenoids, particularly beta-carotene and lutein, may prevent or delay the onset of amyotrophic lateral sclerosis (ALS). The study, published by Wiley in Annals of Neurology, a journal of the American Neurological Association and Child Neurology Society, found that diets high in lycopene, beta-cryptoxanthin, and vitamin C did not reduce ALS risk.

Carotenoids give fruits and vegetables their bright orange, red, or yellow colors, and are a source of dietary vitamin A. Prior studies report that oxidative stress plays a role in the development of ALS. Further studies have shown that individuals with high intake of antioxidants, such as vitamin E, have a reduced ALS risk. Because vitamin C or carotenoids are also antioxidants, researchers examined their relation to ALS risk.

According to the National Institutes of Neurological Disorders and Stroke (NINDS) roughly 20,000 to 30,000 Americans have ALS—also known as Lou Gehrig’s disease—and another 5,000 patients are diagnosed annually with the disease. ALS is a progressive neurological disease that attacks nerve cells (neurons) in the brain and spinal cord, which control voluntary muscles. As the upper and lower motor neurons degenerate, the muscles they control gradually weaken and waste away, leading to paralysis.

“ALS is a devastating degenerative disease that generally develops between the ages of 40 and 70, and affects more men than women,” said senior author Dr. Alberto Ascherio, Professor of Epidemiology and Nutrition at Harvard School of Public Health in Boston, Mass. “Understanding the impact of food consumption on ALS development is important. Our study is one of the largest to date to examine the role of dietary antioxidants in preventing ALS.”

Using data from five prospective groups: the National Institutes of Health (NIH)–AARP Diet and Health Study, the Cancer Prevention Study II-Nutrition Cohort, the Multiethnic Cohort, the Health Professionals Follow-up Study, and the Nurses’ Health Study, researchers investigated more than one million participants for the present study. A total of 1093 ALS cases were identified after excluding subjects with unlikely food consumption.

The team found that a greater total carotenoid intake was linked to reduced risk of ALS. Individuals who consumed more carotenoids in their diets were more likely to exercise, have an advanced degree, have higher vitamin C consumption, and take vitamin C and E supplements. Furthermore, subjects with diets high in beta-carotene and lutein—found in dark green vegetables—had a lower risk ALS risk. Researchers did not find that lycopene, beta-cryptoxanthin, and vitamin C reduced the risk of ALS. Long-term vitamin C supplement intake was also not associated with lower ALS risk.

Dr. Ascherio concludes, “Our findings suggest that consuming carotenoid-rich foods may help prevent or delay the onset of ALS. Further food-based analyses are needed to examine the impact of dietary nutrients on ALS.”

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The above story is reprinted from materials provided by Wiley, via AlphaGalileo.

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Journal Reference:

Kathryn C Fitzgerald, Éilis J O’Reilly, Elinor Fondell, Guido J Falcone, Marjorie L McCullough, Yikyung Park, Laurence N Kolonel, Alberto Ascherio. Intakes of vitamin C and carotenoids and risk of amyotrophic lateral sclerosis: Pooled results from 5 cohort studies. Annals of Neurology, 2012; DOI: 10.1002/ana.23820

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Cardiac disease linked to higher risk of mental impairment

Tue, 29 Jan 2013 02:48:28 +0000

Cardiac disease linked to higher risk of mental impairment : Human Health & Science

Jan. 28, 2013 Cardiac disease is associated with increased risk of mild cognitive impairment such as problems with language, thinking and judgment — particularly among women with heart disease, a Mayo Clinic study shows. Known as nonamnestic because it doesn’t include memory loss, this type of mild cognitive impairment may be a precursor to vascular and other non-Alzheimer’s dementias, according to the findings published online in JAMA Neurology.

Mild cognitive impairment is an important stage for early detection and intervention in dementia, says lead author, Rosebud Roberts, M.B., Ch.B., a health sciences researcher at Mayo Clinic.

“Prevention and management of cardiac disease and vascular risk factors are likely to reduce the risk,” Roberts says.

Researchers evaluated 2,719 people ages 70 to 89 at the beginning of the study and every 15 months after. Of the 1,450 without mild cognitive impairment at the beginning, 669 had heart disease and 59 (8.8 percent) developed nonamenestic mild cognitive impairment; in comparison 34 (4.4 percent) of 781 who did not have heart disease developed nonamenestic mild cognitive impairment.

The association varied by sex; cardiac disease and mild cognitive impairment appeared together more often among women than in men.

This research was funded by National Institutes of Health grant AG006786 and the Robert H. and Clarice Smith and Abigail van Buren Alzheimer’s Disease Research Program and was made possible by the NIH-funded Rochester Epidemiology Project.

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The above story is reprinted from materials provided by Mayo Clinic.

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Journal Reference:

Rosebud O. Roberts et al. Cardiac Disease Associated With Increased Risk of Nonamnestic Cognitive ImpairmentStronger Effect on Women. JAMA Neurology, 2013 DOI: 10.1001/jamaneurol.2013.607

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Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Guidelines for brain amyloid imaging in Alzheimer’s

Mon, 28 Jan 2013 14:28:40 +0000

Guidelines for brain amyloid imaging in Alzheimer’s : Human Health & Science

Jan. 28, 2013 Only recently has it become possible to create high-quality images of the brain plaques characteristic of Alzheimer’s disease in living people through positron emission tomography (PET). Even so, questions remain about what can be learned from these PET images and which people should have this test.

To provide guidance for physicians, individuals and families affected by Alzheimer’s, and the public, the Society of Nuclear Medicine and Molecular Imaging (SNMMI) and the Alzheimer’s Association have jointly published the first criteria for the appropriate use of this imaging technology to aid in the diagnosis of people with suspected Alzheimer’s disease. The criteria were published online January 28 as an article “in press” by Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association and “ahead of print” in The Journal of Nuclear Medicine.

“Our primary goal is to provide healthcare practitioners with the information and options available to provide patients with the best possible diagnosis and care in a cost effective manner,” said Maria Carrillo, Ph.D., Alzheimer’s Association vice president of Medical and Scientific Relations.

Appropriate Use Criteria (AUC) for Brain Amyloid Imaging with PET in Alzheimer’s

While elevated beta amyloid plaques are one of the defining pathologic features of Alzheimer’s, many elderly people with normal cognition also have elevated levels of these plaques, as do people with conditions other than Alzheimer’s dementia. Therefore, the potential clinical use of amyloid PET requires careful consideration so that its proper role may be identified.

To develop the new criteria, the Alzheimer’s Association and SNMMI assembled an Amyloid Imaging Taskforce (AIT) consisting of dementia and imaging experts to review the scientific literature and develop consensus recommendations for the clinical use of this promising new technology.

The AIT concluded that amyloid imaging could potentially be helpful in the diagnosis of people with cognitive impairment when considered along with other clinical information, and when performed according to standardized protocols by trained staff. In addition, they emphasized that the decision whether or not to order amyloid imaging should be made only after a comprehensive evaluation by a physician experienced in the assessment and diagnosis of cognitive impairment and dementia, and only if the presence or absence of amyloid would increase certainty in the diagnosis and alter the treatment plan.

According to the AIT, appropriate candidates for amyloid PET imaging include:

Those who complain of persistent or progressive unexplained memory problems or confusion and who demonstrate impairments using standard tests of cognition and memory.
Individuals meeting tests for possible Alzheimer’s, but who are unusual in their clinical presentation.
Individuals with progressive dementia and atypically early age of onset (before age 65).

Inappropriate candidates for amyloid PET imaging include:

Those who are age 65 or older and meet standard definitions and tests for Alzheimer’s, since a positive PET scan would provide little added value.
Asymptomatic people or those with a cognitive complaint but no clinical confirmation of impairment.

Amyloid PET imaging is also inappropriate:

As a means of determining the severity of dementia.
When requested solely based on a family history of dementia or presence of other risk factors for Alzheimer’s, such as the ApoE-e4 gene.
As a substitute for genetic testing for mutations that cause Alzheimer’s.
For non-medical reasons, such as insurance, legal or employment decisions.

“As amyloid imaging becomes more prevalent in clinical settings, medical professionals must understand how to appropriately utilize the test,” said Frederic H. Fahey, D.Sc., SNMMI president. “Neurology and dementia experts should order the test only when appropriately indicated, and nuclear medicine and molecular imaging professionals must ensure they have been adequately trained to interpret the results of the scan. Working together, we hope that the information garnered from amyloid PET imaging will aid in diagnosis and play a pivotal role in the development of new treatments for Alzheimer’s.”

The taskforce acknowledged that the healthcare provider makes the ultimate judgment regarding the care of each patient. The AIT sought to assist this process and identified the following general sequence of events for the use of amyloid PET according to the new criteria:

Evaluation by a dementia expert to assess the need for diagnostic testing, possibly to include amyloid PET if the AUC are met.
Referral to a qualified provider of amyloid PET services.
Performance, interpretation and reporting of the amyloid PET scan according to established standards.
Incorporation of the PET result into the clinical assessment process.
Disclosure of the PET result by the clinician to the patient and caregivers, along with discussion of the result and its management consequences.

Although identifying potential benefits, the AIT concluded that amyloid PET results will not constitute and is not equivalent to a clinical diagnosis of Alzheimer’s disease dementia. They said that imaging is only one tool among many that clinicians should use judiciously to manage patients, and that amyloid PET imaging does not substitute for a careful history and examination.

“Because both dementia care and amyloid PET technology are in active development, these new appropriate use criteria will require periodic reassessment and updating,” Carrillo said.

PET Amyloid Imaging in Alzheimer’s — An Overview

PET uses radiopharmaceuticals (radioactive drugs) to produce three-dimensional functional images of the brain or other body part. In amyloid PET imaging, the radiopharmaceutical is introduced into the body by injection into a vein and binds specifically to the amyloid protein, enabling visualization of areas in the brain where amyloid has clumped together into plaques. One of the new PET compounds was approved for general use by the U.S. Food and Drug Administration in April 2012.

If a person with dementia does not have amyloid buildup in their brain, then the cause of the dementia is very likely to be something other than Alzheimer’s disease. Other causes of dementia include: strokes, thyroid problems, drug interactions, chronic alcoholism, and vitamin deficiencies.
If an amyloid imaging PET scan shows that a person with memory impairment has amyloid buildup in their brain, this increases the likelihood that the memory impairment is caused by Alzheimer’s disease, but it remains a likelihood, not a certainty.
If a person without memory complaints or impairment has amyloid buildup, it does not necessarily mean that they will develop Alzheimer’s. Many people have amyloid in their brains but are cognitively normal. More research is needed to understand the significance of amyloid plaques in this population.

Amyloid imaging is not covered by insurance at this time, and costs for the scan are “out of pocket.” While costs of amyloid PET are not yet established, and PET costs in general can vary depending upon location, other PET scans are known to cost between $1,000 and $3,000, or more. Nonetheless, the AIT concluded that the proven sensitivity and specificity of the new radiopharmaceuticals for brain amyloid and the known association between brain beta amyloid deposition and Alzheimer’s suggest these new radiopharmaceuticals could potentially be helpful in the workup and diagnosis of patients with cognitive impairment.

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The above story is reprinted from materials provided by Society of Nuclear Medicine, via EurekAlert!, a service of AAAS.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.

Journal Reference:

Maria C. Carrillo, Kaj Blennow, Holly Soares, Piotr Lewczuk, Niklas Mattsson, Pankaj Oberoi, Robert Umek, Manu Vandijck, Salvatore Salamone, Tobias Bittner, Leslie M. Shaw, Diane Stephenson, Lisa Bain, Henrik Zetterberg. Global standardization measurement of cerebral spinal fluid for Alzheimer’s disease: An update from the Alzheimer’s Association Global Biomarkers Consortium. Alzheimer’s & Dementia, 2012; DOI: 10.1016/j.jalz.2012.11.003

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Guidelines for brain amyloid imaging in Alzheimer’s

Mon, 28 Jan 2013 14:24:13 +0000

Guidelines for brain amyloid imaging in Alzheimer’s : Human Health & Science

Appropriate Use Criteria (AUC) for Brain Amyloid Imaging with PET in Alzheimer’s

According to the AIT, appropriate candidates for amyloid PET imaging include:

Those who complain of persistent or progressive unexplained memory problems or confusion and who demonstrate impairments using standard tests of cognition and memory.
Individuals meeting tests for possible Alzheimer’s, but who are unusual in their clinical presentation.
Individuals with progressive dementia and atypically early age of onset (before age 65).

Inappropriate candidates for amyloid PET imaging include:

Those who are age 65 or older and meet standard definitions and tests for Alzheimer’s, since a positive PET scan would provide little added value.
Asymptomatic people or those with a cognitive complaint but no clinical confirmation of impairment.

Amyloid PET imaging is also inappropriate:

As a means of determining the severity of dementia.
When requested solely based on a family history of dementia or presence of other risk factors for Alzheimer’s, such as the ApoE-e4 gene.
As a substitute for genetic testing for mutations that cause Alzheimer’s.
For non-medical reasons, such as insurance, legal or employment decisions.

Evaluation by a dementia expert to assess the need for diagnostic testing, possibly to include amyloid PET if the AUC are met.
Referral to a qualified provider of amyloid PET services.
Performance, interpretation and reporting of the amyloid PET scan according to established standards.
Incorporation of the PET result into the clinical assessment process.
Disclosure of the PET result by the clinician to the patient and caregivers, along with discussion of the result and its management consequences.

“Because both dementia care and amyloid PET technology are in active development, these new appropriate use criteria will require periodic reassessment and updating,” Carrillo said.

PET Amyloid Imaging in Alzheimer’s — An Overview

If a person with dementia does not have amyloid buildup in their brain, then the cause of the dementia is very likely to be something other than Alzheimer’s disease. Other causes of dementia include: strokes, thyroid problems, drug interactions, chronic alcoholism, and vitamin deficiencies.
If an amyloid imaging PET scan shows that a person with memory impairment has amyloid buildup in their brain, this increases the likelihood that the memory impairment is caused by Alzheimer’s disease, but it remains a likelihood, not a certainty.
If a person without memory complaints or impairment has amyloid buildup, it does not necessarily mean that they will develop Alzheimer’s. Many people have amyloid in their brains but are cognitively normal. More research is needed to understand the significance of amyloid plaques in this population.

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The above story is reprinted from materials provided by Society of Nuclear Medicine, via EurekAlert!, a service of AAAS.

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Journal Reference:

Maria C. Carrillo, Kaj Blennow, Holly Soares, Piotr Lewczuk, Niklas Mattsson, Pankaj Oberoi, Robert Umek, Manu Vandijck, Salvatore Salamone, Tobias Bittner, Leslie M. Shaw, Diane Stephenson, Lisa Bain, Henrik Zetterberg. Global standardization measurement of cerebral spinal fluid for Alzheimer’s disease: An update from the Alzheimer’s Association Global Biomarkers Consortium. Alzheimer’s & Dementia, 2012; DOI: 10.1016/j.jalz.2012.11.003

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