Doctors have a new way of scanning the brain for signs of Alzheimer's disease. But despite its potential to help clear up uncertainties for people with mild symptoms of dementia, most patients are not getting the scan.
In April, the U.S. Food and Drug Administration approved Amyvid, an agent that highlights beta-amyloid plaques found in the brains of people with Alzheimer's, making them visible on PET scans.
But so far, insurers --notably, the federal government, whose lead the private companies usually follow --aren't paying for the tests.
The only central Ohio hospital offering the scans is Ohio State University's Wexner Medical Center, where Amyvid is used in clinical trials and is available to other patients at an out-of-pocket cost of $3,570.
Nationally, about 300 practices or hospitals offer the scans or will soon, said Morry Smulevitz, spokesman for Lilly Bio-Medicines, which makes Amyvid.
So far, Ohio State has scanned three patients who were offered the service free as part of Lilly's start-up program with centers that are providing the scans.
The Centers for Medicare and Medicaid Services is considering covering the scans, a process that is likely to take about a year, Smulevitz said in an email.
Dr. Douglas Scharre, the director of OSU's Division of Cognitive Neurology, said the technology is a good tool for differentiating between early Alzheimer's and other mild cognitive impairment and could better guide doctors' recommendations.
Scharre suggests early treatment with Alzheimer's medications for those patients he suspects are showing signs of the disease, but he can't be certain he's correct without the scan.
The greatest potential lies in the future and is pinned on the hope that researchers will find a drug shown to get rid of amyloid in the brain and decrease or eliminate symptoms of the disease, said Scharre, who also is medical director of Ohio State's neurobehavior and memory disorders clinics.
Dr. Nathan Hall, the chief of nuclear medicine at Ohio State, agreed that the scans currently have the most potential for those who have mild disease that might be Alzheimer's because it could increase early treatment.
"Preventing progression is something that's a possibility now," he said.
One of Scharre's patients, a 71-year-old Powell man who received one of the free scans, said it was helpful to get confirmation that there are beta-amyloid plaques in his brain.
"There is so little information about this impairment that whatever information you can get is good," his wife said. "It doesn't make you feel better, but it makes you feel better-informed and more in control."
The couple asked that their names not be published, to protect his medical privacy.
A little more than three years ago, her husband began to notice he couldn't find the words he wanted to speak. Recently, the symptoms worsened, he said.
His wife said she hopes insurance companies will recognize the value of the scans to doctors and patients.
Scharre said he already had prescribed medications for Alzheimer's, based on cognitive symptoms, but the scan confirmed that what he was doing had the potential to help delay the disease. Early use of medications has been shown in multiple studies to have more impact on Alzheimer's.
Patti, another patient who asked that her last name not be published, said the scan she received at no cost helped make her diagnosis clearer. The 81-year-old Northwest Side woman said she felt a little better having confirmation that there is evidence of the disease in her brain.
FDA information on Amyvid warns that errors might occur in the reading of scans. Side effects from the agent were rare in studies and included headaches, body pain, fatigue and nausea.
Like all other PET scans, these contribute to patients' lifetime radiation exposure.
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OCTOBER 31, 2014
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