Biologically speaking, there is no organ as vital or complex as the brain. While there have been immense breakthroughs in medicine, from the discovery of insulin in 1922 to the invention of the MRI machine in 1972, the labyrinth of neurology still remains somewhat of a mystery to many experts. This is especially true when it comes to treating diseases like Alzheimer’s and Parkinsons, something Dr. Kellyann Niotis, a preventive neurologist specializing in risk reduction strategies, understands better than most.
“Most people think they don’t have to worry about diseases like Alzheimer’s or Parkinson’s until they are in their 60s or 70s, but that’s a big misconception,” Dr. Niotis told Flow Space. “My work centers on preventive neurology, aiming to identify and mitigate risk before neurological symptoms manifest using a precision medicine approach.”
Women face a heightened risk of developing dementia over their lifetime. In fact, approximately twice as many women are diagnosed with Alzheimer’s disease, the most prevalent form of dementia, compared to men. Because of this, healthcare providers have increasingly turned to brain scans for select patients in recent years. But when should women consider getting one, and what specific conditions can it help detect?
Who should get a brain scan?
Before deciding if a brain scan is right for you, it’s important to first understand what it is and why someone might need one. The brain is made up of white matter (nerve fibers surrounded by a fatty protective coating) and gray matter (primarily composed of brain cell bodies). A brain MRI is an important way to assess the health of both these components. Certain brain MRI sequences allow doctors to assess the integrity of the white matter.
Determining when to undergo a brain scan depends on various factors, including your medical history, symptoms, and risk factors. While there’s no perfect age to get a brain scan, establishing a healthy baseline before the age of 45 can be helpful, Dr. Niotis says, especially for those at elevated risk for neurodegenerative disease.
“With age, the brain undergoes structural changes such as a deterioration in the protective coating surrounding brain cells (AKA white matter) and decrease in the number of neurons (AKA gray matter) and connections between neurons (synapses).” Dr. Niotis says. “This is because brain volume declines at a rate of 5 percent per decade after the age of 40 to 45.”
In addition, Dr. Niotis mentioned that identifying any changes early allows for the best proactive care. Jessica Caldwell, Ph.D. and director of the Women’s Alzheimer’s Movement Prevention & Research Center at Cleveland Clinic says it’s not really recommended at a particular age go out and get a brain scan. Caldwell explains that what is recommended is if someone is worried about their thinking, they should go to their doctor and get tested regardless of their age.
“Oftentimes, the initial tests are going to be paper and pencil tests,” Caldwell says. “They’re very brief. But then if there are concerns that come up, you might be asked to have a number of different things for further testing. That could be brain imaging. It could be neuropsychology tests, or bloodwork. It’s really the imaging isn’t the first point of entry if you have a concern about your brain, but it certainly could be ordered if the doctor agrees that something is wrong.”
What can scans tell us about our brain health?
In the realm of women’s health, understanding your brain’s well-being is crucial, even when you’re feeling your best. There are many different types of brain scans, each with their own indication. In someone with cognitive complaints, Dr. Niotis says the most common brain scans performed are Amyloid PET scans and FDG-PET scans.
“Amyloid PET scans tell us if someone has accumulated the toxic protein Amyloid-Beta that is associated with Alzheimer’s disease, whereas FDG-PET scans measure glucose in the brain, revealing how the brain is using energy,” Dr. Niotis says. “Distinct patterns of glucose metabolism in the brain can help doctors diagnose various neurodegenerative diseases.”
In a healthy person without neurological complaints, a brain MRI serves as an essential diagnostic tool for evaluating brain health. It offers intricate images of the brain and its structural components, including white matter (comprising nerve fibers shielded by a fatty coating) and gray matter (mainly consisting of brain cell bodies). By providing detailed insights into these elements, a brain MRI aids in comprehensive assessment of brain health.
“Certain brain MRI sequences allow us to assess the integrity of the white matter. Occasionally, we can see ‘white spots’ or white matter hyperintensities, which are abnormalities in the white matter,” Dr. Niotis says. “These are more common with age, but often are the result of reduced blood flow to the small blood vessels in the brain often due to insulin resistance, high blood pressure and high cholesterol. White matter hyperintensities are associated with cognitive decline, dementia and increased risk for stroke.”
Niotis went on to say that neurodegenerative diseases cause accelerated brain shrinkage, especially in the gray matter, in specific regions. When a neurologist or another type of doctor requests an MRI, Caldwell explains that they are frequently searching for changes in brain volume that may signal dementia, as well as alterations in the brain’s white matter or neuronal connections.
“This could indicate some different types of problems, for example, this could indicate strokes or autoimmune processes. So there are many different things that an MRI can reveal that could be helpful when it comes to your thinking. And PET scan or Positron Emission Tomography is used really to detect the activity of your brain indicated by how much sugar different parts of your brain are using and the reason to get this scan is to map that on to your volume of your brain essentially.”
It’s important to keep in mind that a brain scan is only as good as the person interpreting the images, Dr. Niotis says. She recommends having a neurologist or brain health expert review the images. For a healthy person, Dr. Niotis mentions that a brain MRI is not covered by insurance and brain volumetrics are never covered by insurance. The out-of-pocket cost for a brain MRI varies but can range from $1900 to $3500.