Thursday, July 20, 2017

How PET imaging results could change Alzheimer’s diagnosis and treatment

“A significant portion of people with mild cognitive impairment or dementia who are taking medication for Alzheimer’s may not actually have the disease, according to interim results of a major study underway to see how PET scans could change the nature of Alzheimer’s diagnosis and treatment.

“The findings, presented Wednesday at the Alzheimer’s Association International Conference in London, come from a four-year study launched in 2016 that is testing over 18,000 Medicare beneficiaries with mild cognitive impairment (MCI) or dementia to see if their brains contain the amyloid plaques that are one of the two hallmarks of the disease.

“So far, the results have been dramatic. Among 4,000 people tested so far in the Imaging Dementia-Evidence for Amyloid Scanning (IDEAS) study, researchers from the Memory and Aging Center at the University of California at San Francisco found that just 54.3 percent of MCI patients and 70.5 percent of dementia patients had the plaques.

“A positive test for amyloid does not mean someone has Alzheimer’s, though its presence precedes the disease and increases the risk of progression. But a negative test definitively means a person does not have it.

“The findings could change the way doctors treat people in these hard-to-diagnose groups and save money being spent on inappropriate medication. ‘If someone had a putative diagnosis of Alzheimer’s disease, they might be on an Alzheimer’s drug like Aricept or Namenda,’ said James Hendrix, the Alzheimer Association’s director of global science initiatives who co-presented the findings. ‘What if they had a PET scan and it showed that they didn’t have amyloid in their brain? Their physician would take them off that drug and look for something else.’

“For decades, diagnosing Alzheimer’s has been a guessing game, based on looking at a person’s symptoms rather than testing for definitive evidence of the brain disorder. A firm diagnosis was not possible until an autopsy was performed. Now, a spinal tap or PET scan can detect the telltale amyloid deposits, and researchers are trying to develop a simple blood test that would do so. PET imaging can quantify the amount of amyloid and also show where it is in a person’s brain.

“But spinal taps are invasive, and PET scans cost $3,000 to $4,000 and are typically not covered by insurance. In 2013 the Centers for Medicare & Medicaid Services (CMS) declined to cover the tests, citing insufficient evidence that they would make a difference for patients with a disease for which there is no cure and limited treatment available.

“But CMS agreed to fund the bulk of the $100 million IDEAS study by reimbursing participants for their PET scans, and researchers hope positive results will persuade them to cover it in the future.

“Over 400 physicians enrolled their patients in the study, and they initially filled out forms describing how they would care for them based on their clinical symptoms. After seeing the PET imaging results, they changed their care plans for two-thirds of the patients in the study. ‘We thought we would be able to see about a 30 percent change, but we’re getting a 66 percent change, so it’s huge,’ Hendrix said. ‘We see high percentages of people who are on a drug and didn’t need to be on those drugs’” (PET scans show many Alzheimer’s patients may not actually have the disease b

Wednesday, July 19, 2017

A Study Suggests Verbal Changes and Hearing Loss Might Be Early Signs of Alzheimer’s Disease

“Your speech may, um, help reveal if you’re uh ... developing thinking problems. More pauses, filler words and other verbal changes might be an early sign of mental decline, which can lead to Alzheimer’s disease, a study suggests.

“Researchers had people describe a picture they were shown in taped sessions two years apart. Those with early-stage mild cognitive impairment slid much faster on certain verbal skills than those who didn’t develop thinking problems. ‘What we’ve discovered here is there are aspects of language that are affected earlier than we thought,’ before or at the same time that memory problems emerge, said one study leader, Sterling Johnson of the University of Wisconsin-Madison.

“This was the largest study ever done of speech analysis for this purpose, and if more testing confirms its value, it might offer a simple, cheap way to help screen people for very early signs of mental decline. 

“Don’t panic: Lots of people say ‘um’ and have trouble quickly recalling names as they age, and that doesn’t mean trouble is on the way. ‘In normal aging, it’s something that may come back to you later and it’s not going to disrupt the whole conversation,’ another study leader, Kimberly Mueller, explained. ‘The difference here is, it is more frequent in a short period,’ interferes with communication and gets worse over time.

“The study was discussed Monday [July 17] at the Alzheimer’s Association International Conference in London. About 47 million people worldwide have dementia, and Alzheimer’s is the most common type. In the U.S., about 5.5 million people have the disease. Current drugs can’t slow or reverse it, just ease symptoms. Doctors think treatment might need to start sooner to do any good, so there’s a push to find early signs.

“Mild cognitive impairment causes changes that are noticeable to the person or others, but not enough to interfere with daily life. It doesn’t mean these folks will develop Alzheimer’s, but many do — 15 to 20 percent per year.

“To see if speech analysis can find early signs, researchers first did the picture-description test on 400 people without cognitive problems and saw no change over time in verbal skills. Next, they tested 264 participants in the Wisconsin Registry for Alzheimer’s Prevention, a long-running study of people in their 50s and 60s, most of whom have a parent with Alzheimer’s and might be at higher risk for the disease themselves. Of those, 64 already had signs of early decline or developed it over the next two years, according to other neurological tests they took.

“In the second round of tests, they declined faster on content (ideas they expressed) and fluency (the flow of speech and how many pauses and filler words they used.) They used more pronouns such as ‘it’ or ‘they’ instead of specific names for things, spoke in shorter sentences and took longer to convey what they had to say. ‘Those are all indicators of struggling with that computational load that the brain has to conduct’ and supports the role of this test to detect decline, said Julie Liss, a speech expert at Arizona State University with no role in the work.

“She helped lead a study in 2015 that analyzed dozens of press conferences by former President Ronald Reagan and found evidence of speech changes more than a decade before he was diagnosed with Alzheimer’s. She also co-founded a company that analyzes speech for many neurological problems, including dementia, traumatic brain injury and Parkinson’s disease.

“Researchers could not estimate the cost of testing for a single patient, but for a doctor to offer it requires only a digital tape recorder and a computer program or app to analyze results...

“Another study at the conference on Monday, led by doctoral student Taylor Fields, hints that hearing loss may be another clue to possible mental decline. It involved 783 people from the same Wisconsin registry project. Those who said at the start of the study that they had been diagnosed with hearing loss were more than twice as likely to develop mild cognitive impairment over the next five years as those who did not start out with a hearing problem. That sort of information is not strong evidence, but it fits with earlier work along those lines.

“Family doctors ‘can do a lot to help us if they knew what to look for’ to catch early signs of decline, said Maria Carrillo, the Alzheimer’s Association’s chief science officer. Hearing loss, verbal changes and other known risks such as sleep problems might warrant a referral to a neurologist for a dementia check, she said.”

___ Audio of example test:

Tuesday, July 18, 2017

Why WEP?/ How WEP Can Affect Your Benefit/ Factors that may, or may not, affect your retirement benefits include

“[The] Windfall Elimination Provision affected 1.7 million beneficiaries at the end of 2015, according to the Social Security Administration, while [the] Government Pension Offset impacted about 652,000...”

Why WEP?


“Why would government workers be treated differently from everyone else? The answer begins with the way that Social Security benefits are distributed across wage-earners with varying incomes.

“Social Security's benefit formula is progressive; workers with low average lifetime earnings get a higher benefit amount compared with their earnings than people who are better paid.

“The formula does not distinguish between workers who had low wages and those who worked for part of their careers in jobs not covered by Social Security. Many federal and state jobs are outside the system because they are covered by government pension plans.

“The WEP aims to eliminate the high benefit return these workers get on their Social Security income when they are not really low-income.

“The impact of the WEP is reduced for workers who spend 21 to 29 years in Social Security-covered work, and it is eliminated entirely for those who spend 30 years or more in such jobs.

“For federal employees, the WEP applies only to workers who started their federal employment before 1983, were covered by the Civil Service Retirement System and did not contribute to Social Security.

“The provision does not apply to people covered by the newer Federal Employees Retirement System, which is a defined contribution plan. Those workers contribute to Social Security…”

For the complete article, click here.

“If you work for a federal, state or local government agency, a nonprofit organization or in another country, you may be eligible for a pension based on earnings not covered by Social Security. 

“A pension based on earnings not covered by Social Security can affect the amount of your Social Security benefit. We do not know whether you are eligible for such a pension, so the benefit estimates you have received may not have been adjusted for such a possibility.

“[This] Windfall Elimination Provision fact sheet explains whether you might be affected. 

How WEP Can Affect Your Benefit 

“If you think your pension will affect your Social Security benefit, you can
Factors that may, or may not, affect your retirement benefits include: