What is the best Brain Scan for early signs of dementia

Newcomer introductions, personal anecdotes, caregiver issues, lab results, and n=1 experimentation.
Post Reply
5Brains
New User
New User
Posts: 2
Joined: Sun Aug 01, 2021 5:06 pm

What is the best Brain Scan for early signs of dementia

Post by 5Brains »

Because I'm 48 (APOE 4/4) and not showing symptoms of dementia I have had a hard time finding a neurologist to help me determine which scan to get for a baseline of my brain. I'm attempting to schedule a scan on my own without a doctor's order, paid out of pocket. I read about the SPECT scan in Dr. Bredesen's book and would love to know if it is the best of the best to find early signs or if it's just as good to have a regular MRI and if so, do I need to request volumetrics? This is a new language for me so any knowledge appreciated.

SPECT scan with Dr. Amen
https://www.amenclinics.com/approach/why-spect/


Envrad - I am able to schedule an MRI of the head only but not sure if it's the right type to see dementia which I think is an MRI with volumetrics? 
https://www.envrad.com/services/mri-scans/


Prenuvo - full body or head and torso scan, again I'm not sure if this type will show dementia? 
https://www.prenuvo.com/contact
User avatar
Tincup
Mod
Mod
Posts: 3317
Joined: Fri Aug 08, 2014 2:57 pm
Location: Front Range, CO

Re: What is the best Brain Scan for early signs of dementia

Post by Tincup »

5Brains wrote: Mon Sep 26, 2022 2:12 pm Envrad - I am able to schedule an MRI of the head only but not sure if it's the right type to see dementia which I think is an MRI with volumetrics? 
https://www.envrad.com/services/mri-scans/
Have no input on your question, however, my understanding is that MRI gadolinium contrast media is not ideal for you. Hence if an MRI really needs to be done, then do it. If I was just curious, I would not do one myself.
Tincup
E3,E4
5Brains
New User
New User
Posts: 2
Joined: Sun Aug 01, 2021 5:06 pm

Re: What is the best Brain Scan for early signs of dementia

Post by 5Brains »

After further reading, it sounds like fMRI (fNCI) is what I'd like for the most detailed info.
Alexia C
Support Team Intern
Support Team Intern
Posts: 57
Joined: Tue Jul 05, 2022 3:20 pm

Re: What is the best Brain Scan for early signs of dementia

Post by Alexia C »

5Brains wrote: Mon Sep 26, 2022 2:43 pm After further reading, it sounds like fMRI (fNCI) is what I'd like for the most detailed info.
Welcome to the forum! Thank you for your inquiry and I am sure others will be providing you with some feedback. I see you are step ahead and got tested. I am a strong believer that the more you know, the more opportunities you will have to take the preventive steps to further minimize your risk.

As a welcome intern, I would like to point out some links/resources that might be helpful as you explore the site further. The Primer includes researched-based prevention strategies. It has been written by Stavia, a practicing M.D. with ApoE4/4.

Some helpful tips to navigate the site include the How-To Guide. It includes topics such as navigating the forum, private messaging, and searching. One great tip is using the quote (") button when replying to a post. Using the button will automatically alert the member of your response.

If you would like to tell us more about yourself or are interested in learning more about other members check out
Our Stories. You might find other members with experiences similar to yours. I used the search option in the top right for ‘fMRI’ and found a couple of conversations that touch on this if you want to check them out.

Again, I am so glad you joined our forum and hope you find the support you need. I look forward to hearing from you in the future.

Best,

Alexia C
NF52
Support Team
Support Team
Posts: 2265
Joined: Tue Oct 25, 2016 9:41 am
Location: Eastern U.S.

Re: What is the best Brain Scan for early signs of dementia

Post by NF52 »

5Brains wrote: Mon Sep 26, 2022 2:12 pm Because I'm 48 (APOE 4/4) and not showing symptoms of dementia I have had a hard time finding a neurologist to help me determine which scan to get for a baseline of my brain. I'm attempting to schedule a scan on my own without a doctor's order, paid out of pocket....
Welcome 5Brains,

I'm a 70 year old woman with ApoE 4/4 and a strong family history of Alzheimer's and vascular dementia and heart disease. I have had a number of MRIs and also PET scans since the age of 64 as part of clinical trials for healthy people with normal cognition. My MRIs still come back delightfully boring!

Your desire to be proactive and to know more about your current brain is wonderful and suggests you have an approach to life that is positive and action-oriented. My assumption is that you see yourself in the future taking that fMRI scan to another neurologist and saying "Let's see if it's changed in X years." You're the kind of inquisitive person that researchers love! But you're also a bit on the young side (IMHO) to get results from an fMRI that will allow you to say "OK, now I can see that....". From my own experience as someone who was not very metabolically healthy at age 48, it's very possible to reach age 70 with ApoE 4/4 and normal cognition.

Most current studies don't use fMRI's, probably because they're more expensive than MRIs and because current MRIs can show microhemorraghes, areas of white-matter hyperintensities (signs of vascular injury), areas of possible atrophy and edema. PET scans and now plasma tests used in screening for research can show amyloid plaques and tau. Most of those changes are not going to be seen in people until at least age of 55 or older, although some current trials screen people as young as 50 with history of memory changes or MCI diagnosis--which you don't have.

From a quick Google Scholar search, here's some recent info on what studies using fMRIs have shown:

1) If you're are a woman in peri-menopause, an fMRI might show changes that seem to be associated, sometimes transiently, with changes in estrogen uptake in the brain. Below are two links, one about a study and the second a peer-reviewed paper.

Both reference research done by Dr. Lisa Mosconi of Weill-Cornell Medical Center with peri-menopausal and post-menopausal women. She has written a book titled The XX Brain that you might find helpful. From a quick overview, these would seem to suggest that a) there are changes in perimenopause and b) those changes are lessened in women who take estradiol or HRT post-menopause. Imaging Study Reveals Brain Changes During the Transition to Menopause Association of Reproductive History With Brain MRI Biomarkers of Dementia Risk in Midlife

Whether an fMI you receive outside of a study like these would indicate a comparison to "normal ranges" of mid-life women is something you might want to ask a potential provider. Another use of an fMRI can be to look for signs of cerebral vascular disease,

2) This is an excerpt of a 2022 pre-print (not yet peer-reviewed) abstract of a study looking to see if fMRI outperforms the Framingham Risk Assessment score to predict whether someone had narrowed carotid arteries. (Spoiler alert: It did not in this study. ] A C-IMT test is itself available for about $150, as is a coronary artery scan (CAC) if you have a family history of early heart disease, and are both something your doctor might be willing to order--although you would likely still have to pay for them. I did and was glad to get good news.
Background Human neuroimaging evidence suggests that cardiovascular disease (CVD) risk may relate to functional and structural features of the brain. The present study tested whether combining functional and structural (multimodal) brain measures, derived from magnetic resonance imaging (MRI), would yield a multivariate brain biomarker that reliably predicts a subclinical marker of CVD risk, carotid-artery intima-media thickness (CA-IMT)....
Results Our models reliably predicted CA-IMT [Carotid artery-medial intimal thickness] using FRS, as well as for several individual MRI measures; however, none of the individual MRI measures outperformed FR [Framingam Risk Scores]. Moreover, stacking functional and structural brain measures with FRS did not boost prediction accuracy above that of FRS alone.

Conclusions Combining multimodal functional and structural brain measures through a stacking algorithm does not appear to yield a reliable brain biomarker of subclinical CVD, as reflected by CA-IMT.
Integrating Multiple Imaging Modalities does not Boost Prediction of Carotid Artery Intima-Media Thickness in Midlife Adults

3) Here's a 2020 review of the literature that found high levels of variability in linking fMRI results to a specific risk profile:
We conducted a narrative review and a quantitative analysis to better understand the relationship between nine categories of AD risk (i.e., brain pathology, genetics/family history, vascular health, head trauma, cognitive decline, engagement in daily life, late-life depression, sex/gender, and ethnoracial group) and task-evoked fMRI activity during episodic memory in cognitively-normal older adults....Although the results clearly indicate that AD risks impact brain activity, we caution against using fMRI as a diagnostic tool for AD at the current time because the above consistencies were present among much variability, even among the same risk factor.
Risk for Alzheimer’s disease: A review of long-term episodic memory encoding and retrieval fMRI studies

If you are interested in finding out if you have biomarkers associated with later risk (not certainty) of changes decades later in the brain, there is an FDA-approved PrecivityAD™ test for amyloid beta in the blood. It too requires a doctor's prescription and is clinically recommended only to confirm the likelihood of Alzheimer's pathology in someone who has clinical signs of cognitive impairment.

My own recommendation, as someone who has lived with the knowledge of ApoE 4/4 only since the age of 62, is to hold off on imaging studies and instead focus on your hormonal health (if you're a woman) and your overall health. Exercise (not marathons!) in mid-life may be especially helpful for your heart and your brain--and your overall mental health too! The strategies recommended in the Primer that Alexia linked above are also super-helpful--and written by Dr. Stavia, a healthy, post-menopausal family practitioner with ApoE 4/4.

Apologies for a TL/DR post and warm wishes for you to find information that brings you hope.

Nancy
4/4 and still an optimist!
User avatar
TCHC
Contributor
Contributor
Posts: 29
Joined: Mon May 02, 2022 6:56 am
Location: UK
Contact:

Re: What is the best Brain Scan for early signs of dementia

Post by TCHC »

I don't know anything about brain scans to be able to help with your specific question. But have you at least tried this cognitive test: https://www.apollohealthco.com/cognitiv ... trial-2022
I do this every 6 months or so and I've seen a real improvement in my scores after working on my lifestyle.
Good luck in your prevention!
Do keep us all in the loop on how you get on.
Lindsey
TCHC - Lindsey Byrne - The Cognitive Health Coach - UK
Functional Medicine Certified Health Coach (FMCHC)
Certified Re:CODE 2.0 Health Coach
mike
Senior Contributor
Senior Contributor
Posts: 772
Joined: Fri Mar 09, 2018 4:55 pm
Location: CA - Sonoma County

Re: What is the best Brain Scan for early signs of dementia

Post by mike »

5Brains wrote: Mon Sep 26, 2022 2:12 pm Because I'm 48 (APOE 4/4) and not showing symptoms of dementia I have had a hard time finding a neurologist to help me determine which scan to get for a baseline of my brain. I'm attempting to schedule a scan on my own without a doctor's order, paid out of pocket. I read about the SPECT scan in Dr. Bredesen's book and would love to know if it is the best of the best to find early signs or if it's just as good to have a regular MRI and if so, do I need to request volumetrics? This is a new language for me so any knowledge appreciated.
There is often neuron loss decades before AD symptoms start. I personally wanted to get a baseline, and so got an MRI with Neuroquant (volumetric). This will tell you if any areas have suffered significant neuron loss, and if so where. The results show how you compare to others your age, and takes into consideration different skull sizes. I had no loss since my stroke 5 years prior, and no mini-bleeds, so with my 4/4 status, it was quite a relief. I got a doctor to prescribe and my insurance paid for 80%. If you did out of pocket, you're probably looking at $600-$1,000.
Sonoma Mike
4/4
Post Reply