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.
For The Record
Los Angeles Times Tuesday December 14, 2004 Home Edition Main News Part A Page 2 National Desk 1 inches; 35 words Type of Material: Correction
Brain scans -- A Monday Health section article about testing for Alzheimer's said a brain scan was a positive emission tomography test. It is a positron emission tomography test, also known as a PET scan.
For The Record
Los Angeles Times Monday December 20, 2004 Home Edition Health Part F Page 6 Features Desk 1 inches; 37 words Type of Material: Correction
Brain scans -- An article in last week's Health section about testing for Alzheimer's said a brain scan was a positive emission tomography test. It is a positron emission tomography test, also known as a PET scan.
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 positive 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 effective as they are when you give them early."
Alzheimer's disease is a progressive brain disorder that causes declines in memory, cognition and functioning. About 10% of Americans over age 65 and half of all people over age 85 have the disease, according to the Alzheimer's Assn. 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," says Schumacher. "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% to 70% of the time, said Dr. Daniel Silverman, director of the UCLA Alzheimer's Disease Center, Imaging Core. PET scanning, meanwhile, is about 91% accurate, he says.
