March 3, 2024

Spinal tap may give definitive prediction of Alzheimer’s

New policy dilemmas

A spinal fluid tap may be 100% accurate in
predicting whether a patient will develop Alzheimer’s disease, according to a
study published in Archives of Neurology.

According to the New York Times, until now
the presence of the disease could only be confirmed after an autopsy, although
it begins ten or more years before symptoms appear. But a simple spinal tap
could predict whether someone has the progressive and incurable brain disease
and identify them as potential subjects for research into cures. “This is what
everyone is looking for, the bull’s-eye of perfect predictive accuracy,” said
Dr Steven DeKosky, dean of the University
of Virginia
medical school.

The news was widely reported in the media
and shot to the top of the most-read articles in the Times. The conumdrums of a
screening test for Alzheimer’s were clear to everyone. Would healthy people
want to know that they have a disease for which there is no cure? How would
they react?

For researchers, the benefits are obvious.
It would be far more efficient to test potential treatments on people in the
initial stage of the disease. In an accompanying editorial, two experts
declared that spinal taps may become a routine “screening test to identify clinically healthy
individuals at risk”. This would be helpful in developing “early application of
treatments to delay onset of symptoms or slow progression of
cognitive impairments”.

Jonathan Moreno, of the University of Pennsylvania, pointed out in The
New Republic
that the existence of an accurate and relatively simple test
creates many policy problems. As many as 5.1 million Americans may have Alzheimer’s.
How will that affect their health insurance? How will it affect families? Will
it lead to suicide or will it encourage people to put their affairs in order? ~
York Times, Aug 9

Michael Cook
Alzheimer’s disease
genetic testing
prenatal testing