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MRIs Show Drug Treatment Slows Brain Deterioration on Road to Alzheimer's Disease

likely to have definite Alzheimer’s disease than noncarriers in the study who appear to have symptoms of early Alzheimer’s disease, yet turn out to have a different diagnosis when an autopsy is performed after death,” he explains.

Brain shrinkage is an essential component of Alzheimer’s disease, says Dr. Jack. “In extreme cases, the brain of an Alzheimer’s patient might weigh half of what a normal person’s brain does at peak health.”

No specific brain volume is diagnostic of Alzheimer’s disease. The key, according to Mayo Clinic’s Dr. Jack, is the rate of brain shrinkage relative to the volume at which a particular person’s brain started.

Testing is required to know one is an APOE 4 carrier. However, experts in Alzheimer’s disease do not recommend everyone undergo testing for APOE 4.

“Being an APOE 4 carrier increases one’s risk for Alzheimer’s disease, but many people who are carriers live into their 90s and don’t get Alzheimer’s,” Dr. Jack says. “Others who are not APOE 4 carriers develop Alzheimer’s. An analogy can be drawn to a cholesterol test, in that a person can have high cholesterol and never develop symptoms of vascular disease. On the other hand, it is not uncommon for people with acceptable cholesterol levels to suffer heart attacks and other complications of vascular disease. So, screening for APOE 4 is not recommended as a diagnostic test to predict who will develop Alzheimer’s disease in the future.”

Dr. Jack says another difficulty with APOE testing is that if one tests positive for APOE 4, nothing can be done about it at present. Ongoing research is investigating potential preventive treatments for those at high risk for developing Alzheimer’s disease, he says.

For those who know they are APOE 4 carriers yet have no signs of mild cognitive impairment, donepezil treatment is not recommended. “It’s proven useful in mild cognitive impairment and Alzheimer’s disease,” says Dr. Jack.
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