NEUROLOGIST CONNECT

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Neurologist Connect by the Numbers

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Slide 6

Patient Care

The Diagnostic Gap in Early Symptomatic Alzheimer’s Disease: Addressing Delays and Enhancing Accuracy

I think the technology that are blood blood-based show the most promise for improving early Alzheimer's diagnosis as this is just an easy and convenient blood test and should be much cheaper and safer for patients rather than radioactive PET scans and invasive CSF spinal tap based tests.

Slide 3

Patient Care

Early identification of Alzheimer's disease is key—recognize the signs and intervene early to slow progression

Slowly progressive cognitive difficulties (particularly with recent memories) in patients over age 65 is usually Alzheimer's disease. If history and cognitive exam (MMSE, Moca, etc) are typical then neuropsychology referral is not necessary and should be reserved for more borderline cases. Otherwise usual work up is warranted (MRI, labs like B12, TSH) although rarely contribute to management. If patients and family are interested in amyloid lowering therapy then biomarker testing with either CSF or amyloid PET is needed. I agree that blood based biomarkers (p-tau 217) may soon replace CSF and PET but as of yet are not covered by insurance and are not adequate to get amyloid lowering therapy approved. Work up is generally straight forward in most patients. Nuance is required for atypical presentations such as younger onset, more rapid progression, non-amnestic presentation or confounding factors such as significant vascular changes, parkinsonism or the very old (over age 85) where LATE may be a contributing factor.

Slide 4

Patient Care

Early identification of Alzheimer's disease is key—recognize the signs and intervene early to slow progression

It Is very important to make the diagnosis of mild cognitive impairment and the early stage of proximal disease. MMSE score is very helpful for determining the mild cases versus moderate cases for versus severe Alzheimer’s disease. Neuropsychological testing also help in the diagnosis of mild cognitive impairment versus early stage of Alzheimer disease. New test available for the amyloid beta 42/40, P-tau protein 217 and 181, also helps in diagnosed the patient's with Alzheimer's disease. PET scan and Amvid tests also diagnose Alzheimer patient. We have been doing skin punch biopsy to diagnose Alzheimer disease for last 5 to 6 years which is also very helpful.

Slide 5

Patient Care

The Diagnostic Gap in Early Symptomatic Alzheimer’s Disease: Addressing Delays and Enhancing Accuracy

The bottom line is that we have too few physicians that are comfortable navigating in this space. In the past, we did not have pathology-specific treatment options, so it was not a critical issue. That has changed, and there are a handful of physicians who monitor these issues, and their ever changing rules, to have comfort in making determination and navigating the path forward, but they are not of sufficient number to handle the volume of potential patients in need. And many of them do not have the support needed to manage this evolving task. It is not a technology issue, but a manpower and healthcare priority problem.

Slide 2

Patient Care

Spinal muscular atrophy: best practices for transitioning patients from pediatric to adult care

This transition requires coordination with an experienced neuromuscular neurologist to ensure that an individual’s physical and emotional care needs are not neglected or delayed. Detailed communication regarding current prescriptions and previous treatments help prepare the specialist who is assuming care of the patient. Ideally, this type of patient will be under the care of a multidisciplinary team which includes physical and occupational therapy, social workers, and psychologists.

NEUROLOGIST CONNECT

A SKIPTA COMMUNITY

Neurologist Connect by the Numbers

What are HCPs talking about?

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