By Michael Shriver, MD – Proscan Imaging NCH Partner
Alzheimer disease is the most common form of dementia and is responsible for 60 to 80% of all neurodegenerative disease in the population. This imposes a significant mental, emotional, and financial burden on nations around the world, including the United States. The prevalence of Alzheimer dementia is directly correlated with age. Approximately 10% of adults 65 and older are diagnosed, compared to 20-40% of those over 85-90 years of age being diagnosed with Alzheimer dementia. An estimated 6.7 million Americans aged 65 and older are living with Alzheimer dementia in 2023. By 2050, it is projected that more than 12.7 million people will be diagnosed with Alzheimer dementia aged 65 and older. At the age of 70, individuals living with Alzheimer dementia are twice as likely to die before the age of 80 than those who do not have the disease. One in three senior citizens will die with Alzheimer or another dementia. Deaths from Alzheimer dementia have doubled between 2000 and 2019, while most other leading causes of death such as heart disease or kidney disease have decreased over that same time period. As well, patients with Alzheimer dementia before age 60 are more likely to have a genetic form of the disease, emphasizing the need for early detection and intervention. Alzheimer dementia is characterized by the accumulation of cerebral amyoid-beta neuritic plaques and Tau neurofibrillary tangles, which eventually result in the loss of neurons.
These abnormal accumulations of material occur in certain areas of the brain that lead to neurocognitive decline in patients over time. While Alzheimer dementia is a common and impactful disease, it is difficult for primary care providers to diagnose and treat, especially early in the disease process when care can be the most important to slow disease progress. Nearly 40% of primary care physicians reported that they “never” or “only sometimes” are comfortable making a diagnosis of Alzheimer dementia. As well, half of primary care physicians report they do not feel adequately prepared to care for individuals with Alzheimer or other dementias.
These stark numbers and difficulty in diagnosing and caring for individuals with dementia are likely related to the heterogeneity of Alzheimer dementia presentation in patients, which makes it hard to identify and appropriately diagnose. In the past, and often still to this day, the definitive diagnosis is only made at the time of autopsy following a patient’s death. This can often result in ambiguity of a patient’s disease, which delays appropriate care. Given Alzheimer dementia’s prevalence, impact on society, and deterioration of individuals and their relationships with loved ones, it is of utmost importance to continue our goal to detect Alzheimer dementia earlier, accurately diagnose patients with the correct form of dementia, and optimize the patient’s care to delay dementia progression and provide patient’s with the best possible life as they move forward. Fortunately, there are new FDA approved medications for the treatment of Alzheimer dementia that have shown a delay in cognitive decline for patients.
These drugs are Aducanumab (AduhelmTM) and Lecanemab (Leqembi). These medications target amyloid plaques, with randomized controlled studies showing a reduction in amyloid plaques over the course of treatment. This further exemplifies the need to diagnose Alzheimer dementia early so that patients can receive these groundbreaking and life-changing treatments. ProScan/NCH Imaging offers a variety of radiology services to help physicians diagnose Alzheimer disease. NeuroQuant MRI of the brain is the first FDA cleared software that allows for the volumetric analysis of brain parenchyma. It provides quantitative volumetric measurements of the brain parenchyma, including cortical, subcortical, cerebellar, deep grey, and brainstem structures/nuclei. NeuroQuant can be used to evaluate for patterns of brain parenchymal volume loss in the setting of memory loss or cognitive impairment. This allows for a more sensitive and accurate understanding of a patient’s neurodegenerative pattern, which affords clinicians the ability to better understand the etiology of a patient’s cognitive impairment. Nuclear medicine imaging also plays a critical role in diagnosing neurodegenerative disorders. F-18 fluorodeoxyglucose (FDG) PET of the brain identifies areas of hypometabolism in the cerebral hemispheres, which is evaluated by a radiologist to identify the pattern of the patient’s neurodegeneration. As well, Amyloid PET uses radiotracers to identify whether amyloid plaques are present or not present in the brain. This will be a critical diagnostic examination to determine if these new groundbreaking Alzheimer treatments are indicated and would be effective for the patient’s care. These radiology imaging examinations offered by ProScan/NCH imaging allow the radiologist to provide the patient’s physicians with detailed, evidence based findings to accurately detect and identify the patient’s neurodegenerative disorder. At ProScan/NCH imaging, these studies are interpreted by board certified Neuroradiologists and Nuclear Medicine physicians, ensuring accurate and precise interpretations. These services will play a critical role in the future care of patients with neurodegenerative diseases, especially Alzheimer dementia.
Dr. Michael Shriver is board eligible by the American College of Radiology and Board Certified by the American Board of Nuclear Medicine. He completed an Integrated Nuclear Radiology Fellowship and Neuroradiology Fellowship at the Hospital of the University of Pennsylvania in Philadelphia. His diagnostic radiology residency was also completed at Penn. Dr. Shriver completed medical school at Case Western Reserve University School of Medicine, Cleveland, OH, and an Internal Medicine Internship at Cleveland Clinic.
Dr. Shriver has relocated to Naples with his wife, Stacy and daughter, Lily. He is excited to add his expertise and experience to the most qualified Radiology services team in the Southwest Florida Region. Our team of talented physicians, caring and professional technologists, and advanced imaging equipment provide our patients with the highest quality of care.
For more information or to schedule an appointment, call 239-624-4443. proscan.com
ProScan Imaging
239-624-4443. proscan.com