APOE4 question
Should I get a baseline brain MRI as an APOE4 carrier without symptoms?
The neurologists in our videos disagree. Dr. Pruzin says no baseline MRI without symptoms unless the result would change a decision, such as starting a blood thinner, while Dr. Gajaweera gets one for her carrier patients so she can compare later. Chance findings on brain scans are common, so ask what you would do differently with the result before you book one.
This is not medical advice. Phoenix educates. Your doctor decides what is right for you.
What the research and Kevin's videos say
What the research says
APOE4-specific evidence: limited
No study shows that a screening brain MRI improves outcomes for carriers without symptoms; in a large population study, about 1 in 14 people had a silent stroke and others had aneurysms or benign tumours found by chance.
Key studies
Vernooij 2007, N Engl J Med
Population MRI study of 2,000 people: silent brain infarcts in 7.2%, aneurysms in 1.8%, benign tumours in 1.6%.
Read on PubMed (opens in a new tab)Cummings 2023, J Prev Alzheimers Dis
Lecanemab use guidance: blood thinners raise bleeding risk, and APOE4 carriers, especially 4/4, have higher risk of brain swelling.
Read on PubMed (opens in a new tab)
What Kevin and experts say
Now showing: Dr. Jeremy Pruzin · 9:49
Open on YouTube (opens in a new tab)
No baseline brain MRI without symptoms or a reason.
“Should I get a baseline MRI? And my answer as a clinician is no.”
Dr. Jeremy Pruzin, Cognitive and behavioral neurologist, Banner Alzheimer's Institute
She gets a baseline brain MRI for carriers to compare later.
“in an E4 carrier? I do get a baseline for it for my patients because I'm looking at your [hippocampal] volume and I'm looking at your white matter changes”
Dr. Ashanthi Gajaweera, Board-certified neurologist, Menopause Society certified practitioner (Healthspan Neurology)
MRI is safe but too costly for frequent checks.
“MRI, the issue, I'd say it's expensive to do it. You don't have any radioactivity issues.”
Dr. Kevin Tran, Founder of The Phoenix Community, Doctor of Pharmacy, APOE4/4 carrier
New MRI may catch neuron loss before shrinkage shows.
“this new technique sees the smoke while the fire is just starting, detecting changes when neurons lost is about 5 to 10%. And incredibly, it only takes 6 minutes.”
Dr. Kevin Tran, Founder of The Phoenix Community, Doctor of Pharmacy, APOE4/4 carrier
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