Phone-Based Tests Can ID Cognitive Problems

By Todd Neale, Staff Writer, MedPage Today

Telephone-based assessments can reliably identify dementia in an ethnically diverse, older population, researchers found.

Two phone-based measures were able to discriminate demented from nondemented individuals and those with mild cognitive impairment from those with dementia, according to Jennifer Manly, PhD, of Columbia University Medical Center in New York City, and colleagues.
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FDA Puts Early Alzheimer's Test on Hold

By Peggy Peck, Executive Editor, MedPage Today

The FDA will not approve the novel contrast agent, florbetapir -- widely touted as a breakthrough for early diagnosis of Alzheimer's disease -- until manufacturer Eli Lilly puts a training program in place, the company announced.
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Study Knocks Diagnostic Value of PSA Velocity

By Charles Bankhead, Staff Writer, MedPage Today

If prostate biopsy is based on PSA velocity alone, the number of unnecessary biopsies would be almost four times the number of additional cancers diagnosed, data from a large clinical trial showed.

In the absence of other predictive factors, PSA velocity would have identified 115 prostate cancers at a cost of 433 unnecessary biopsies, according to Andrew Vickers, PhD, of Memorial Sloan-Kettering Cancer Center in New York City and colleagues.

If used as sole justification for a biopsy, PSA velocity would trigger about one of every seven prostate biopsies, they reported online in the Journal of the National Cancer Institute.

Moreover, adding PSA velocity to a multifactor model resulted in minuscule improvement in diagnostic accuracy, particularly for high-grade cancers.

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QuickStats: Annual Number of Patients Discharged from Hospice Care, by Primary Diagnosis (Cancer Versus All Other Diseases)* --- United States, National Home and Hospice Care Survey, 1992--2007

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Morbidity and Mortality Weekly Report (MMWR)

* Primary diagnosis is assessed on admission for hospice-care services. Estimates are based on the number of discharged patients, the majority of whom leave hospice care at death. Some patients might discontinue care while living, some might reenter care, and some might have more than one episode of care in a 12-month period.

The figure above shows the annual number of patients discharged from hospice care, by primary diagnosis (cancer versus all other diseases) in the United States during 1992-2007. Use of hospice care increased from approximately 219,300 discharged hospice-care patients in 1992 to 1,045,100 in 2007. In 1992, three out of four patients (approximately 163,600) had a primary diagnosis of cancer, compared with 55,500 patients with all other diseases. In 2007, less than half of patients (42%) had a primary diagnosis of cancer, for a total of 447,600 cancer patients, compared with 597,500 patients with all other diseases.

Source: CDC. National Home and Hospice Care Survey data, 1992, 1994, 1996, 1998, 2000, 2002, 2004, and 2007. Additional information available at http://www.cdc.gov/nchs/nhhcs.htm.

QuickStats: Annual Number of Patients Discharged from Hospice Care, by Primary Diagnosis (Cancer Versus All Other Diseases)* --- United States, National Home and Hospice Care Survey, 1992--2007

FDA Okays First 3-D Mammogram Device

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By Cole Petrochko, Staff Writer, MedPage Today

The FDA has approved the first x-ray mammography device that provides 3-D images of the breast.

Approval of the Selenia Dimensions System was based on two studies asking radiologists to review 2-D and/or 3-D images from over 300 mammographies. Radiologists who viewed the 2-D and 3-D models were 7% more accurate in distinguishing cancerous and noncancerous cases than those who only used a 2-D image, an FDA statement said.
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TIME GOES BY | Breakthrough Test for Early Alzheimer's Diagnosis

by Ronni Bennett

Except in autopsy, there has never been a way to diagnose Alzheimer's disease – until now. Last week, the U.S. Food and Drug Administration gave tentative approval to a new screening for early detection in living persons of the unique plaques that define Alzheimer's.

The test, involving a PET scan that uses a dye to make the plaques visible, is relatively inexpensive. The FDA approval is contingent on radiologists and physicians being trained in how to read the scans to help avoid false positives – something that can be done, according to the CEO of the company that developed the dye, in months not years.

A senior director at the Alzheimer's Association expects the test to be available before the end of this year.

In a New York Times story earlier this week, Dr. Norman Foster, a professor of neurology at the University of Utah, discussed a patient with a memory deficit who could have benefited from the test:

“I wish I had had the ability to do an amyloid PET scan to allow an earlier diagnosis,” Dr. Foster said. Approval of the scan, he said, “would be a historic advance in neurology and in the daily management of patients with memory complaints.”

Nothing this big comes along without new, difficult and disturbing questions. In an online video from The Picker Report, the TGB Geriatrician, Dr. Bill Thomas, and dementia expert Dr. Al Power, also a geriatrician, took a whack a some of them.
Long-term care insurance has always been unaffordable for many people and this test, as the doctors note, makes that worse, although it will be interesting to see how the new health care law, which no longer allows denial of coverage for pre-existing conditions, will be applied in this case.

And, there are workplace issues; would people be denied employment if their Alzheimer's test were positive?
The biggest personal question the two doctors discuss briefly is, of course – would you want to know, when you are still cognitively healthy, that you have the plaques identified with Alzheimer's, particularly since there is no treatment.

Practically, it makes sense. People can plan ahead and they might use their time - which could be many years still - differently than if they didn't know. But it could also be detrimental leading to depression and other life difficulties.

I've given this a great deal of thought in the past few days. If the scan showed no plaques, I'm home free and I wouldn't wonder every time I forget someone's name if I'm entering the early stages of Alzheimer's.

If the test were positive, however, I know I would monitor myself for every minor bit of forgetfulness. How far gone am I? Is my memory loss serious yet? How do I know I'm forgetting things if I don't remember what I once knew?

Is this something I want to discuss with anyone beyond my physician? Do I tell relatives? Friends? If so, when? Who decides when I am no longer capable? My physician? My health care proxy?

Because I live in Oregon which has a Death with Dignity law, would I want to take advantage of that before my mind is an empty shell? But if my brain is heading south, how would I know when I've hit the tipping point, so to speak? Obviously, one can make an informed decision to choose to die only when one's mind is coherent, so there are legal questions too.

It is difficult to work out and there are no precedents yet, no guides from others' experience.

But at my age, nearly 70, I've tentatively come down on the side of wanting to know, although I won't be first in line when the test becomes available. I'm certain there are ramifications that haven't occurred to me yet.
(I think it is an even tougher question for people who are a good deal younger than I am. Would you want to know 20 or 30 or 40 years before the disease begins to be evident? I'm glad I'm too old to confront that.)
Most of the people reading this blog are, like me, older than 50. So the question today is: do you, at your age now, want to know if your brain shows the Alzheimer's plaques? And will you have the test when it becomes available?

This is not a question that can be tossed off easily like what to have for dessert and you may not have an answer today. But I think it is useful for all of us to begin the conversation.

TIME GOES BY | Breakthrough Test for Early Alzheimer's Diagnosis

Lab Notes: Test for AD Not Ready for Prime Time

By MedPage Today Staff

Researchers working on a novel method for identifying disease biomarkers used it to identify some autoantibodies apparently related to Alzheimer's disease.

But the work fell far short of producing a blood test for the disease, as press releases and numerous headlines have suggested.

What the researchers from the Scripps Research Institute in Jupiter, Fla., actually did was develop a platform for extracting disease-related biomarkers from body fluid samples. It's based on a surface coated with random "peptoid" molecules with shapes that might capture specific proteins in the samples.

When applied to blood samples from Alzheimer's disease patients and normal controls, the approached turned up two IgG proteins that were present in most of the patients but few of the controls.

But the experiments, which were reported in Cell, did not examine the presence of these antibodies in individuals with other forms of dementia or mild cognitive impairment nor their behavior over time -- necessary steps for a test for predicting or diagnosing Alzheimer's disease.

Medical News: Lab Notes: Test for AD Not Ready for Prime Time - in Lab Notes, Lab Notes from MedPage Today

Simple Question Aids Parkinson's Diagnosis

By John Gever, Senior Editor, MedPage Today

Dutch researchers said they have found a way to distinguish atypical Parkinson's disease from the more common standard form: asking patients if they can still ride a bicycle.

When the question was put to 111 consecutive patients with Parkinson's disease, nearly all those who said it had become impossible were subsequently determined to have the atypical form, according to Bastiaan Bloem, PhD, and colleagues at Nijmegen Medical Center in the Netherlands.
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