This is a promising era for scientists probing the diseases that can ravage aging and traumatized brains.  Advances in neuroimaging have opened a new window on living brains, allowing physicians to pinpoint degenerative disorders when the information can be useful to patients and their families. Until recently, the amyloid plaques and tau tangles that denote the likely presence of Alzheimer’s disease and other brain disorders did not appear on brain scans, and were visible only at autopsy.

“This is a huge breakthrough in imaging,” says Sarah Banks, PhD, ABPP/CN, Head of Neuropsychology at Cleveland Clinic Lou Ruvo Center for Brain Health. An explosion of information gained from scanning living patients is impacting both clinical care and research.

Unmasking Amyloid PlaquesA
The Food and Drug Administration (FDA) has approved the clinical use of Positron Emission Tomography (PET) to screen for amyloid plaques – a significant step because, uniquely, a PET scan can reveal very early cellular-level metabolic changes occurring in organs or tissues.

The main hurdle to clinical use is cost: Medicare does not yet cover amyloid PET scans, which can run up to $5,000. The Lou Ruvo Center for Brain Health is participating in the national, multicenter IDEAS study to assess the impact of brain amyloid PET imaging. Results of this study could be pivotal in securing future insurance reimbursement.

Some people with amyloid plaques never develop the memory loss associated with Alzheimer’s disease, so a positive scan is not definitive proof that dementia will occur. But the test can serve as an early warning, prompting patients to plan ahead and to enroll in clinical trials that may benefit them. Conversely, a negative scan can bring relief to those who feared their memory problems were caused by Alzheimer’s disease.

Tau Tangles and Impaired Memory
PET screening for the tau protein is experimental, so it can be deployed in research studies but not in clinical care. Tau tangles have been found not only in the brains of Alzheimer’s patients, but in athletes who have experienced memory loss and behavioral problems. This syndrome, widely publicized in professional football players, is known as chronic traumatic encephalopathy (CTE).

At the Lou Ruvo Center for Brain Health, active and retired boxers and mixed martial arts fighters in the Professional Fighters Brain Health Study are receiving tau PET scans in an effort to detect early signs of brain injury and to identify those most likely to develop chronic neurological disorders.

“CTE remains a controversial diagnosis,” says Dr. Banks. “Studying the brains of athletes here, we will be on the front lines in better understanding the relationship between injury and disease. If we can scan reliably for a range of brain pathologies – from sports-related injury to Alzheimer’s to frontotemporal dementia – we can learn so much more about them even as we improve the accuracy of our diagnoses.”

For more information about neuroimaging and the Cleveland Clinic Lou Ruvo Center for Brain Health visit my.clevelandclinic.org/locations_directions/nevada/imaging.

 Photo: Sarah Banks, PhD, ABPP/CN, Head of Neuropsychology at Cleveland Clinic Lou Ruvo Center for Brain Health