PET Scan is the test. See article below - I'll post the whole article because I'm not sure if you will have to log in to my local paper to see it:
PET scans likely to become more popular in Alzheimer's fight
By Shari Roan, Los Angeles Times
January 10, 2005
For almost three years, Janelle Lafser pleaded with doctors to order a PET scan for her husband, Frank.
He had been experiencing memory and mood problems -- beginning at age 45 -- and was having trouble in his job as an executive at a paint company. The doctors said he was depressed, but Janelle was unconvinced.
She told them that her husband forgot plans the couple had made, misplaced things and found paying bills too confusing. She suspected Alzheimer's disease and wanted the positron emission tomography test because it can provide physical evidence of the disease.
Physicians steadfastly refused, telling her that Frank was too young to have Alzheimer's, which occurs mostly in people age 65 and older.
"I think you want that diagnosis," an exasperated neurologist told Janelle one day when she again requested a PET scan to look for Alzheimer's.
"I want the truth," she snapped back.
Finally, when his doctors recommended electric shock treatments for depression, Janelle made it contingent upon a PET scan that showed no abnormalities. Only then did the Lafsers, who live in La Quinta, get the scan. As Janelle suspected, Frank had Alzheimer's disease.
Until recently, PET scanning has been seldom used in the diagnosis and treatment of Alzheimer's, even though it is billed as "a window to the brain" and is the only test, other than an autopsy, to offer physical proof of the disease. At about $1,500 per exam, doctors have deemed it too expensive and too experimental, with many saying a scan would be of little practical benefit to a patient with an incurable disease.
But some families have increasingly countered that they need a specific diagnosis of Alzheimer's -- backed by a PET scan -- to ensure proper treatment and to plan for their loved ones' gradual deterioration.
Now, more of them will know what type of treatment to pursue and whether to make long-term arrangements. In October, Medicare announced that it would begin to pay for PET scans in some patients with signs of the disease, a move that is expected to lead to increased coverage by private insurers as well.
That move could be just the beginning. Many experts predict that, within the next decade, PET scanning also may be recommended for healthy people who lack symptoms but who are at high risk for developing the disease. For these people, the tests may determine whether their brains are already exhibiting signs of degeneration.
Alzheimer's physicians and researchers say PET scanning will lead to better diagnoses in the short term and -- with other brain-imaging techniques and blood tests in development -- to preventive treatment of Alzheimer's in the long term.
"PET scanning is going to be a very powerful tool in the future," says Dr. Richard Powers, a trustee of the Alzheimer's Foundation of America and chief of the bureau of general psychiatry for the Alabama Department of Mental Health.
"The problem with Alzheimer's treatment right now is we are waiting until folks are so demented before diagnosing them that the treatments are not as ef-fective as they are when you give them early," Powers said.
Alzheimer's disease is a progressive brain disorder that causes declines in memory, cognition and functioning. About 10 percent of Americans over age 65 and half of all people over age 85 have the disease, according to the Alzheimer's Association. No one knows what causes Alzheimer's, although most researchers believe there are genetic influences.
PET produces images of the brain's activity; most other imaging devices only show structures in the brain. During a PET scan, a radioactive substance is injected into the body and a scanner tracks the resulting signals. The procedure is considered extremely safe because only a small amount of radiation is required.
Currently, the vast majority of people with Alzheimer's disease don't undergo the scans, says Robert J. Schumacher, vice president of the western region for Molecular Imaging Corp., a major provider of PET services, based in San Diego. Most are diagnosed after a comprehensive work-up that essentially rules out other causes of dementia. This approach includes a physical exam, lab tests and extensive psychological and cognitive tests.
"The pioneers have been using PET for Alzheimer's for about 10 years," Schumacher says. "But, as far as across the board, most people don't know this tool is out there."
The traditional office assessment for Alzheimer's disease can take months or years and is less accurate than PET scanning, advocates of the scan say.
Widely accepted research shows that traditional methods diagnose Alzheimer's accurately only 60 percent to 70 percent of the time, said Dr. Daniel Silverman, director of theAlzheimer's Disease Center, Imaging Core, at the University of California, Los Angeles. PET scanning, meanwhile, is about 91 percent accurate, he says.
The use of PET varies widely among doctors and medical centers. Patients or their families with financial or educational resources tend to request PET scans and pay out-of-pocket, while the average, elderly person with memory problems knows nothing of the technology or can't afford it, said Dr. Peter Conti, director of the PET center at the University of Southern California and president-elect of the Society of Nuclear Medicine.
In ruling that it would pay for PET scans for some people suspected of having Alzheimer's, the Centers for Medicare and Medicaid Services stopped short of endorsing the scans as a general diagnostic test for the disease. Instead, Medicare and Medicaid will only cover the test for those patients whose symptoms are not typical and who doctors believe may have either Alzheimer's disease or one of several other brain disorders known as fronto-temporal dementia.
But it's a significant first step, says Dr. William Bradley Jr., chairman of the department of radiology at University of California, San Diego.
"It's a big deal that CMS decided to cover it," Bradley says. "If you can use diagnostic imaging equipment like PET earlier and either slow a disease or cure it altogether, that is going to save money in the long run."
Currently, experts agree that the best use for PET in the Alzheimer's arena is to help doctors figure out if a patient has the disease when the standard work-up has not produced a clear answer.