Ask the Experts: Blood Test for Alzheimer’s; GERD and Esophageal Cancer; COPD Inhalers and Fracture Risk
I recently read that a diagnostic lab is offering a new blood test for Alzheimer’s disease. I don’t have serious memory issues, but I do have a family history of Alzheimer’s. Should I get this test?
The test to which you refer can be purchased online and requires approval by a telehealth doctor; you then attend a local lab to provide a blood sample.
The test is marketed as an option for people who have memory issues and/or a family history of Alzheimer’s disease (AD). You are in the latter category—however, I have reservations about the test. The test measures two forms of an abnormal brain protein called amyloid-beta (A-beta) in the blood—Abeta 42 and A-beta 40—and provides an A-beta 42/40 ratio. Some research suggests that the ratio may help identify who is at risk of developing AD. However, the test has not undergone long-term large-scale testing, so it is unclear if it has any useful predictive value. An important thing to keep in mind here is that we don’t know for sure whether A-beta causes AD—many older adults with high levels of the protein in their brains remain cognitively normal until death. If you were to get the test and the results gave cause for concern, this likely would result in significant anxiety, possibly unnecessarily. Moreover, the test is not approved by the U.S. Food & Drug Administration.
If you are set on getting tested, I recommend you ask your doctor to refer you to a specialized memory clinic where a comprehensive evaluation can be carried out using a range of tests. Should the results be positive, these clinics also have trained counselors to provide emotional support, discuss treatment options with you, and help you formulate a plan for your future care.
Rosanne M. Leipzig, MD, PhD
Geriatric Medicine
I am able to manage my gastroesophageal reflux disease with lifestyle approaches, but is it true that it raises the risk of esophageal cancer?
Several studies have shown that people who have gastroesophageal reflux disease (GERD) are more likely to develop esophageal cancer, with older men most vulnerable. GERD results in digestive acid leaking out of the stomach into the lower esophagus (the muscular tube that links the back of the throat to the stomach). The cells that form the inner lining of the stomach are protected against the corrosive properties of digestive acid by a layer of mucus, but the cells that line the esophagus do not have this safeguard. If GERD is not well controlled, long-term exposure to the acid may inflame the lining of the esophagus (a condition known as esophagitis), and the cells may develop mutations that lead to cancer. All that said, a recent large study (BMJ, Sept. 13, 2023) suggests that the risk of esophageal cancer in most people with GERD may have been overstated. The Swedish study tracked about 485,000 people for up to 31 years and found that the risk was elevated only in people who had evidence of esophagitis. The takeaway is that you shouldn’t panic about the link between these conditions, particularly if your GERD symptoms are well controlled.
Brijen J. Shah, MD
Gastroenterology
I use an inhaler to manage COPD, but I recently read that inhalers raise the risk of fractures. Should I stop using mine?
A recent large study review suggested that using an inhaler containing a corticosteroid drug may increase the risk of fractures. The mechanism underlying the association is unclear; however, studies have shown that oral corticosteroids—which often are taken to help control chronic obstructive pulmonary disease (COPD)—can have serious effects on bone if given for a prolonged course. Inhaled corticosteroids have been associated with similar findings in many publications, although with a much lower incidence, presumably because of lesser systemic absorption.
Your letter does not clarify what the active ingredient is in your inhaler, but many of these devices don’t contain a corticosteroid. If you are unsure whether yours does, are worried about your treatment regimen, or are in a high-risk category for bone fracture (for example, you are age 65 or older, or have severe COPD), ask your pulmonologist if a different medication is advisable.
E. Neil Schachter, MD
Pulmonary Medicine
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