Jennifer Rose V. Molano, MD reviewing Boccardi M et al. JAMA Neurol 2016 Oct 31.
Amyloid positron emission tomography imaging may affect diagnostic and treatment decisions in patients with cognitive impairment.
Amyloid positron emission tomography (PET) using [18F]-florbetapir can be a biomarker for Alzheimer disease (AD). In this open-label, multicenter study, dementia experts from 18 northern Italian centers diagnosed patients with AD or non-AD after a comprehensive evaluation, rated their diagnostic confidence on a 0–100 scale, and determined whether to start cognitive medications prior to amyloid imaging. After patients underwent amyloid imaging, experts were informed of the results and reassessed their diagnoses, diagnostic confidence, and treatment plan.
Among 228 study participants, experts diagnosed 165 AD patients with a diagnostic confidence of 71% and 63 non-AD patients with a diagnostic confidence of 30%. Mild cognitive impairment was diagnosed in 54.5% of the AD group and 31.7% of the non-AD group. In the 137 amyloid-positive patients, 89.8% received a final diagnosis of AD. A final non-AD diagnosis was given in 86.8% of the amyloid-negative patients. An amyloid-negative scan changed the final diagnosis to non-AD from a prescan diagnosis of AD more often than an amyloid-positive scan changed a prescan non-AD diagnosis to AD. Diagnostic confidence increased when both the pre- and postscan diagnosis was AD and when the diagnosis changed from non-AD to AD. Diagnostic confidence decreased when the diagnosis changed from AD to non-AD and when both pre- and postscan diagnoses were non-AD. Cognitive medications were started in 65.6% of previously untreated amyloid-positive patients and discontinued in 33.3% of treated amyloid-negative patients.
CITATION(S):
Boccardi M et al. Assessment of the incremental diagnostic value of florbetapir F 18 imaging in patients with cognitive impairment: The Incremental Diagnostic Value of Amyloid PET With [18F]-Florbetapir (INDIA-FBP) study. JAMA Neurol 2016 Oct 31; [e-pub].
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