Scientists at the University of Pennsylvania have developed a screening test for Alzheimer’s disease.

They claim the test can detect the condition before symptom onset and predict whether patients with mild cognitive impairment will progress to the full-blown syndrome.
 
The test involves measuring cerebrospinal fluid concentrations of the disease’s 2 principal biochemical hallmarks—amyloid beta42 peptide and tau protein.

Compared with unaffected people, Alzheimer’s patients have decreased levels of the former and increased levels of the latter.
 
“With this test, we can detect and track progression of Alzheimer’s disease,” Leslie Shaw asserted to BurrillReport.

The co-director of Penn’s Alzheimer’s Disease Neuroimaging Initiative and lead author of the study added, “validated biomarkers will improve the focus of Alzheimer’s clinical trials, enrolling patients at earlier stages of the disease to find treatments that can delay, and perhaps stop neurodegeneration.”
 
Shaw and her colleagues wrote it up in Annals of Neurology.

The scientists examined CSF samples from 410 volunteers at 56 sites in the US and Canada, as well as 52 presumed normal volunteers and post-mortem specimens from 56 patients with autopsy-proven Alzheimer’s disease.
 
The test was 87 percent accurate overall.

It correctly ruled out Alzheimer’s in 95% of normal volunteers, correctly detected the disease in 96% of those with autopsy-proven disease, and predicted conversion from mild cognitive impairment to Alzheimer’s in 82% of participants.

Further validation studies are underway. 
 
“We have validated a test where a safe, simple lumbar puncture can provide information to confirm suspected Alzheimer’s disease and predict the onset of the disease,” John Trojanowski told Burrill.

The director of the Penn Alzheimer’s Disease Core Center added that “using this technique, we will further our understanding of how the disease progresses and what we can do to stop Alzheimer’s disease before it starts.”

Norm Eisen, the Big O’s Ethics Czar is a busy guy.

Eisen, who guards his boss’ integrity like Curtis Sliwa, is the go-to guy every time someone in the new administration needs a curbside consult on how ethical government is supposed to work.
 
Can we hire that former lobbyist? Better call Norm. Is it OK to accept presents from former clients? Blow it by Norm. Need to brief a new appointee on the Big O’s ethics policies? Norm’s the guy.

The man gets yanked from his desk to handle emergencies like this 20 times per day, according to the Washington Post.

A former Obama classmate at Harvard Law, Eisen apparently didn’t have trouble crafting an executive order that resulted in the most comprehensive government ethics reform in a generation.

That order prohibited people who had lobbied government in the last 2 years from working in the Obama administration, and permanently banned anyone who left the administration from returning as a lobbyist.

It’s enforcing the rules that makes him sweat.

And the pressure’s been turned up since Daschle’s and Tiny Tim’s tax problems dropped shoe polish on the otherwise pristine start. Now Eisen helps vet pretty much all administrative positions.

And when he’s not doing that he’s hounding interns to sign their ethics pledge, crafting rules on economic regulatory reform and shaping all manner of public policy.
 
“He’s the original propeller-head ethics geek, like something right out of ‘The West Wing’ TV show,” White House chief council Gregory Craig told the Post.

“Everybody loves Norm. I don’t go anywhere without him. I don’t leave home without Norm on these issues.”

Dr. George Taler makes house calls!

The Washington Hospital Center-based physician belongs to an intrepid tribe of providers that are reviving a lost art one tongue-depressor at a time. 

Back in the 1930s, 40% of all encounters with physicians occurred in the home, but that number dropped to 10% by 1950, and 1% by 1980, according to Helen Kao and colleagues whose article appears in Clinics in Geriatric Medicine.

Patients preferred to visit hospitals and clinics, which were perceived to be modern wonders, jam-packed with gee-whiz diagnostic tools and treatments that became the sine qua non of medicine in the second half of the century.

Or, as Kao’s team put it, “house calls became old fashioned.”

Financial incentives also drove the migration. Physicians who opted for lucrative, technology-driven specialties found themselves tethered to the facility-based machines, while PCPs deduced that they could triple visit counts by having patients come to them rather than the other way around. 

Then, about a decade ago Medicare began facilitating payment to physicians who made home visits to the elderly and chronically ill, and sweetened their reimbursement pot by 50%.

Since then, physician home visits have risen from 1.5 million to 2.2 million.

“There is growing interest,” Constance Row told the Washington Post. The executive director of the American Academy of Home Care Physicians added it’s a “win-win situation for everyone. It is one of those things that patients, their families and caregivers want and also something that (could) save money.”

And ironically, technology–which helped undermine house calls 50 years ago–now assures that physician home visits are more productive than ever.

Nowadays, physicians carry laptops, electronic medical records, portable EKG machines, and ultrasound machines right into the bedroom.