Connect with us

Science

Opinion: Too many older Americans are getting tested for Alzheimer's

Published

on

Opinion: Too many older Americans are getting tested for Alzheimer's

An 80-something patient came in for an annual visit recently and was worried that recent memory lapses might be symptoms of Alzheimer’s disease. This patient, like several others in my practice, has taken cognitive tests annually for more than a decade.

With each passing year, I see and hear the patient’s spiral of worry: Am I getting more forgetful? Perhaps it feels like “Where are my keys?” and “Where did I leave my wallet?” have become common refrains. These are simple memory lapses, an experience most people have throughout their lives, but they can be troubling as we get older. Are they signs of Alzheimer’s? Or signs of that other dreadful A-word … aging?

Year after year, for 10 years, in fact, this patient’s cognitive tests had come back normal. Until this year, when a blood test was positive for biomarkers for Alzheimer’s — triggering a further sense of panic. But here’s the problem: Science can’t yet tell us whether a positive test means the patient has an early stage of the disease. The only new data point was that this patient, so long dreading this day, had positive biomarkers showing increased risk for the disease. This person may not develop full-blown Alzheimer’s for five years or 20 years or ever. So did running that test have any benefit?

There is a sense of urgency in the medical community to classify a positive biomarker test as “Stage One Alzheimer’s Disease.” This is part of a larger desire to appear aggressive in fighting the disease, which for so long had no tests and no course of treatment.

I get that, and I understand why so many older patients fear Alzheimer’s, but I disagree with doctors whose response is to test early and often — and to diagnose Stage One Alzheimer’s based solely on biomarkers.

Advertisement

That categorization is potentially dangerous to patients, an unnecessary source of middle-of-the-night stress that can be deeply damaging to the very quality of life this person seeks to retain.

Such worries have become more widespread recently as the biomarker blood tests, marketed by companies like Quest and Labcorp, became commercially available so that patients could pay for them out of pocket. Previously, they were only used by clinicians in studies.

There’s an understandable impulse behind the medical community’s push to test lots of people. The more the disease is diagnosed, the more individuals will be identified for future treatments, and there is no doubt we need to improve recognition of early dementia, especially in medically underserved populations.

At the same time, pharmaceutical companies need more clinical trials — and also more patients — to develop new drugs to add to the array that already exists, such as Leqembi. In an aging nation with 7 million people already diagnosed with Alzheimer’s, we need these drugs, badly, but there’s no denying that profit lurks in the background as a motive here as well.

Although there are good reasons to test lots of people and gather a larger pool of patients who might have early stage Alzheimer’s, I think the cost to specific individuals can be just too great.

Advertisement

Candidates for clinical trials should not be identified based on positive blood tests from a clinical setting, but rather through carefully conducted research studies that have proper counseling and disclosure protocols.

More than 40% of individuals over 80 who take a biomarker test for Alzheimer’s will test positive. And it’s natural that many of them then will fixate on the worst-case scenarios and live their lives with a sense of worry and dread.

Patients who’ve tested positive come to me and bluntly state, “I have Alzheimer’s.” I see the scared look on their faces. Reaching this conclusion based on the biomarkers is like diagnosing cancer without doing a biopsy. The danger is real: Half of the patients who actually do have Alzheimer’s experience some sort of depression, and so do quite a few who think they have it — or worry they are sure to get it.

A positive blood biomarker test could also lead to significant mental and financial damage, with unnecessary and expensive procedures like an MRI, a PET scan or a spinal fluid test. Some people don’t like to hear this, but in many cases simple lifestyle changes like exercise, more rest and healthier eating could improve cognitive function. This is the recommendation I make to all my patients regardless of their Alzheimer’s risk.

For now, the biomarker test should be taken only if you are truly showing signs of Alzheimer’s disease. Here are some ways to tell: If a loved one is experiencing noticeable changes from their baseline mental abilities — such as losing track of time and place or struggling to find words — that can be a sign. Personality changes and new mood symptoms are other warning signs. Still, these symptoms should be distinguished from the slow and steady decline we will all experience.

Advertisement

If you do have symptoms, then yes, it could be time for biomarker tests, but only after thorough cognitive testing and a complete review of your medical history. That medical history could show other conditions such as sleep apnea that can influence memory. Lifestyle changes or treatments of those other conditions could resolve the troubling symptoms.

My stance on widespread testing will be different when doctors have more tools available to predict and treat Alzheimer’s and can offer constructive advice after a blood test comes back positive.

When someone has a cancerous tumor, surgeons remove it as soon as possible and start a treatment plan. When someone tests positive for the gene that indicates risk for a certain type of cancer, we monitor carefully.

A positive Alzheimer’s biomarker test, on the other hand, leads to no changes in clinical management when there are no cognitive symptoms. Prevention trials and improved predictive biomarkers for Alzheimer’s disease will change that, but we’re not there yet.

In the meantime, doctors’ oath to “do no harm” should mean we avoid overdiagnosing Alzheimer’s and fueling needless anxiety.

Advertisement

Keith Vossel is a professor of neurology at UCLA.

Continue Reading
Advertisement
Click to comment

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Science

A tale worth telling of four women scientists whose names you should know but don't

Published

on

A tale worth telling of four women scientists whose names you should know but don't

Book Review

Sisters in Science: How Four Women Physicists Escaped Nazi Germany and Made Scientific History

By Olivia Campbell
Park Row Books: 368 pages, $32.99
If you buy books on our site, The Times may earn a commission from Bookshop.org, whose fees support independent bookstores.

Advertisement

You might have heard of Lise Meitner. A native of Austria, she was the first woman to become a full professor of physics in Germany. She also helped discover nuclear fission. Yet the 1944 Nobel Prize for Chemistry for that accomplishment went solely to her longtime collaborator, Otto Hahn.

Meitner battled misogyny and sexism at every stage of her illustrious career. But growing antisemitism and the 1933 Nazi takeover of Germany were an even higher-order problem. Although she was a convert to Lutheranism, her Jewish heritage endangered her. With the help of friends, she was able to flee in 1938 to neutral Sweden, where she was safe but scientifically isolated. “I can never discuss my experiments with anyone who understands them,” she wrote to fellow physicist Hedwig Kohn.

In “Sisters in Science,” Olivia Campbell tells the intertwined stories of Meitner and three other notable, but lesser known, women physicists from Germany: Kohn, Hertha Sponer and Hildegard Stücklen. Only Kohn was Jewish, but the Third Reich’s hostility to women academics cost the other two jobs as well.

Cover photo of “Sisters in Science”

(Park Row Books)

Advertisement

All three eventually made it to the United States, where they pursued their careers and continued to support one another (and Meitner too). Kohn, the last to escape, didn’t make it out of Europe until 1940. She endured two months of arduous travel through the Soviet Union and Japan and across the Pacific Ocean, barely surviving the ordeal.

Theirs is an inspiring tale, and well worth telling — all the more so because, as Campbell notes in her dedication, so many other women academics were murdered by the Nazis. “Their absence haunts this book; the rippling impact of their loss affects us all,” she writes.

But its intrinsic interest notwithstanding, “Sisters in Science” is a sometimes frustrating read. Part of the problem is its ambitious scope. Group biography is a tricky genre. Campbell has to meld four narrative arcs: parallel at times, overlapping at others, but also divergent. A more elegant stylist, or a true adept of narrative nonfiction, might have managed to integrate these stories more seamlessly. It doesn’t help that Campbell refers to her protagonists by their first names — and three of the four begin with the letter “H.”

Explaining the physics to a lay audience is another challenge, perhaps an insuperable one. Campbell attempts it only nominally. The idea of fission, the splitting of atomic nuclei and resulting production of vast amounts of energy, is more or less intelligible. But the accomplishments of the other three physicists, who worked in spectroscopy, optics and astrophysics, are harder to grasp.

Advertisement

The book also would have benefited from better copy editing and fact-checking. Whatever her bona fides as a science journalist, Campbell is not at home in Holocaust history. One example: Campbell locates Dachau, the Nazis’ first concentration camp, in Oranienburg, a suburb of Berlin. Dachau opened in 1933 in the town of Dachau, near Munich. Oranienburg was actually the site of another eponymous camp and then, in 1936, Sachsenhausen.

There are other errors and infelicities. Campbell continually refers to Kristallnacht, the November 1938 Nazi pogrom, as “the Kristallnacht.” A more serious lapse is her anachronistic suggestion that, in 1938, Meitner feared being deported to a “death camp.” Camps such as Dachau and Sachsenhausen were brutal, often murderous places, but in the 1930s, they mostly housed Nazi political opponents (some of them Jewish). Jews were not yet being deported from Germany, and the six death camps dedicated to their extermination — places such as Sobibor, Treblinka and Auschwitz-Birkenau, all in Poland — did not become operational until the early 1940s.

It is also somewhat crude, and arguably inaccurate, to say that Kristallnacht “exposed the Nazis’ true agenda for the Jewish people: they wanted them all dead.” Despite the growing virulence of anti-Jewish persecution, that goal was not yet clear, and not yet official policy. In fact, though some were killed, most of the 30,000 or so Jewish men rounded up and taken to concentration camps during Kristallnacht were released on the condition that they emigrate.

Presumably Campbell is on firmer ground elsewhere — in noting, for instance, the difficulties that women scientists faced in Germany, including fights for pay, lab space and recognition; and in emphasizing the ways that they, and a few sympathetic male colleagues, helped one another endure, flourish and eventually escape.

When she first became Hahn’s assistant in Berlin, for example, Meitner was exiled from the main lab and stuck in a basement workshop with no nearby restroom. She ultimately rose to head the physics department at Berlin’s Kaiser Wilhelm Institute for Chemistry, a post she retained even after her Nazi-era dismissal from the University of Berlin.

Advertisement

Some male scientists were dead set against women. Others, such as Max Planck, welcomed collaboration from only the most exceptional of their female peers. One heroic supporter of women in science was the Nobel laureate James Franck. A German Jew, he resigned his post at the University of Göttingen before he could be fired, immigrated to the United States via Denmark, and was later instrumental in aiding colleagues, including women, who remained behind.

Franck and Sponer, his onetime assistant, were especially close — both friends and scientific collaborators. After a stint at the University of Oslo, Sponer accepted a position at North Carolina’s Duke University in 1936, and began working with Edward Teller, the eventual creator of the hydrogen bomb, “on the vibrational excitation of polyatomic molecules by electron collisions.”

Only after Franck’s wife died in 1942 did his long-germinating romance with Sponer come to fruition. He remained at the University of Chicago, and she at Duke. But in 1946, they married, and in Campbell’s sympathetic telling, experienced true happiness amid the sorrows around them.

Julia M. Klein is a cultural reporter and critic in Philadelphia.

Advertisement
Continue Reading

Science

Doctor surrenders license after allegations that he sexually abused patients and employees

Published

on

Doctor surrenders license after allegations that he sexually abused patients and employees

A longtime internist who founded a chain of Southern California clinics has surrendered his medical license after an accusation from the state medical board that he sexually assaulted three patients, two of whom worked for his clinics.

Dr. Mohammad Rasekhi signed an agreement to give up his medical license last month, weeks after the Medical Board of California filed an accusation against him detailing allegations that Rasekhi sexually abused three women while they were under his care.

Rasekhi denies all the allegations, his attorney Peter Osinoff said this week. He chose to waive his rights to a hearing and retire from medicine, a decision Osinoff said his client had been considering for some time.

“For him to spend his retirement money litigating over a license he no longer uses is not a good use of money,” Osinoff said. The surrender took effect Dec. 2.

Rasekhi was the founder and chief medical officer of Southern California Medical Center, a group of general practice clinics with locations in El Monte, Van Nuys, Pico Rivera, Woodland Hills, Pomona and Long Beach.

Advertisement

Sheila Busheri, co-founder of Southern California Medical Center and Rasekhi’s spouse, declined to comment.

In a document filed Oct. 3, the state medical board accused Rasekhi of sexual exploitation and gross negligence in his treatment of three patients.

The first became a primary care patient of Rasekhi’s around 2005, when she was 12 years old. In 2016, she accepted a job at SCMC while still seeing Rasekhi for her medical care.

Soon after, Rasekhi began making sexually suggestive comments to her at work, the document states. These progressed to unwanted sexual contact the woman endured for fear of losing her job, according to the complaint. The abuse continued until she went on medical leave in 2020.

The medical board reviewed records of the woman’s doctor appointments with Rasekhi. According to her chart, Rasekhi performed breast exams on the patient during visits for seemingly unrelated complaints such as back pain and hair loss, the accusation states.

Advertisement

“Respondent denied performing breast exams during those visits and conceded that the medical record does not accurately reflect the details about the visit or the examinations actually performed,” the complaint states.

A second patient began seeing Rasekhi in 2016 at the age of 62. In September 2017, the complaint states, Rasekhi arrived unannounced at the patient’s home.

“After entering Patient 2’s home and without Patient 2’s consent and over Patient 2’s protests, Respondent made sexual advances towards, and had sexual contact with, Patient 2,” the complaint said.

A third patient was employed at SCMC from 2007 to 2017, and became a patient of Rasekhi’s in 2015. Rasekhi made frequent suggestive comments at work that escalated into advances and sexual contact that continued until her resignation, the complaint stated.

A woman whose employment dates matched those of the third patient settled with Rasekhi, Busheri and SCMC for $3.5 million in 2019, according to a report in the Daily Journal.

Advertisement
Continue Reading

Science

Avocados, salmon, strawberry yogurt: Which of these meets FDA's new definition of a “healthy” food?

Published

on

Avocados, salmon, strawberry yogurt: Which of these meets FDA's new definition of a “healthy” food?

In an effort to improve American diets, the U.S. Food and Drug Administration Thursday released a new definition of what it means for a food to qualify as “healthy.”

Products like fruit-flavored yogurt, fortified white bread and sweetened energy bars will no longer be allowed to label themselves as healthy if they exceed certain limits on saturated fat, sodium and added sugars.

At the same time, foods like salmon, almonds and even water will qualify as healthy for the first time.

The new definition reflects the advice offered in the Dietary Guidelines for Americans, which are produced by the Department of Agriculture and the Department of Health and Human Services. The hope is that consumers who consider health claims on packaged foods while filling their grocery carts will be steered toward a more nutritious eating pattern, the FDA said.

Advertisement

There’s no question that Americans can use some help with their diets. For example, less than half of U.S. adults eat a piece of fruit on any given day, and only 12% consume the recommended 1.5 to 2 cups of fruit per day, according to national surveys conducted by the Centers for Disease Control and Prevention. Americans are even further off the mark with vegetables, with only 10% meeting the target of 2 to 3 cups per day.

On the other hand, 90% of us eat too much sodium, 75% eat too much saturated fat and 63% eat too many added sugars, the FDA said.

The new definition of healthy foods aims to turn that around by excluding foods with excess sodium, saturated fat and added sugars even if they also contain valuable nutrients like protein and whole grains.

The specific limits vary depending on food groups. The limits will also depend on whether a product is an individual food (like cheese), a “mixed product” (like trail mix) or a complete meal (like a frozen dinner).

For instance, in order for a dairy product such as yogurt to qualify as healthy, a single 2/3-cup serving can’t have more than 5% of the recommended daily amount of added sugars, 10% of the recommended daily amount of sodium or 10% of the recommended daily amount of saturated fat.

Advertisement

Those limits translate to 2.5 grams of added sugars, 230 milligrams of sodium and 2 grams of saturated fat. A single serving of Chobani strawberry Greek yogurt would miss the mark because it contains 9 grams of added sugars. So would Chobani’s “less sugar” variety, which has 5 grams of added sugars.

Sugar, salt and fat are only part of the new criteria. To meet the new definition of healthy, foods must contain a minimum amount of protein, whole grains, fruit, vegetables or fat-free or low-fat dairy, the FDA said.

Whole foods like eggs, beans, seafood and nuts will automatically qualify as healthy if they are sold with no added ingredients (except for water). That makes foods like avocados, olive oil and higher-fat fish like salmon eligible to be labeled as healthy for the first time. Fruits, vegetables and fish can make the cut if they are fresh, frozen or canned, making them accessible to people on a range of budgets, the agency said.

However, products like fortified breads, cereals, fruit snacks, granola bars and fruit punch will lose the label unless they are reformulated to meet the new definition.

Nancy Brown, chief executive of the American Heart Assn., said the new definition was long overdue and hopes it will improve Americans’ diets by motivating food manufacturers to create healthier products. However, she added that it would be more meaningful to require products to carry a nutrition label on the front of their packages, which she believes would make it easier for consumers to identify and select healthier options.

Advertisement

The previous definition of healthy foods, which was issued in 1994, focused more on total fat and cholesterol. Since then, nutrition scientists have recognized that not all fats should be treated the same, and that unsaturated fats found in nuts, seeds, fish and certain vegetable oils can lower disease risk.

The old definition also required foods to provide at least 10% of the recommended daily amount of vitamin A, vitamin C, calcium, iron, protein or fiber. The FDA said it is shifting its focus from specific nutrients to larger food groups in order to help consumers build a healthy dietary pattern.

Poor diet is a risk factor for many of the leading causes of death in the U.S., including heart disease, stroke, diabetes and some types of cancer.

Food manufacturers will have three years to conform to the new definition, the FDA said, though those that meet the new criteria don’t have to wait that long to start using the “healthy” label.

Advertisement
Continue Reading
Advertisement

Trending