|The Making and Unmaking of Alzheimers Disease|
Award Year: 2008
When is Alzheimer's disease (AD) a diagnosis and when is it a prediction? As we develop new tests to identify a person's propensity for the disease, and as we expand the definition of Alzheimer's to include patients with "preclinical AD", "prodromal AD", and mild cognitive impairment, we blur the line between diagnosis and risk assessment. With that comes the potential to harm patients and to overburden our system by treating what is actually normal, age-related cognitive change. Jason Karlawish, M.D. explores how our understanding of brain aging is changing and raising controversies. In his project, The Making and Unmaking of Alzheimer's Disease, he examines issues such as disagreements among experts about how to define and treat dementia, the use of neuroimaging, Medicare reimbursement for PET scans, genetic testing, healthy brain initiatives, and the emerging market for brain fitness activities. Dr. Karlawish considers the actors involved - from clinicians, researchers, and pharma to advocacy organizations, patients, and families - as well as the ethical, economic, and policy implications of changes in how AD is defined and measured. The project's results will contribute to policy debates about the value of costly testing, preventive treatments, and public health initiatives to maintain brain health.