Impact of Amyloid PET Imaging in the Memory Clinic: A Systematic Review and Meta-Analysis

Shea, Yat‐Fung; Barker, Warren W.; Greig-Gusto, Maria T.; Loewenstein, David; Duara, Ranjan; DeKosky, Steven T.

doi:10.3233/jad-180239

Cited by 32 publications

(42 citation statements)

References 34 publications

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“…First, the nonrandomized design and lack of a control group limit the direct attribution of changes in management to PET. However, the rates of changes in management were similar to those reported in randomized studies, 20,21 and physicians ascribed a large majority of all changes to the scan results. Second, patients were in-cluded in the study based on criteria that "knowledge of PET results is expected to change diagnosis and management."…”

Section: Limitationssupporting

confidence: 70%

“…16 Rates of change in both groups were significantly higher than the a priori target threshold of 30% and were comparable to results reported in smaller studies and recent meta-analyses. [20][21][22] The most frequent change in management involved the use of Alzheimer disease drugs, the aspect of management most directly tied to etiologic diagnosis. Cholinesterase inhibitors and memantine are approved for the symptomatic treatment of Alzheimer disease, 23 and cholinesterase inhibitors also show some efficacy in the treatment of dementia with Lewy bodies and Parkinson disease dementia, 24 conditions that often involve amyloid deposition.…”

Section: Discussionmentioning

confidence: 99%

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Association of Amyloid Positron Emission Tomography With Subsequent Change in Clinical Management Among Medicare Beneficiaries With Mild Cognitive Impairment or Dementia

Rabinovici

Gatsonis

Apgar

et al. 2019

JAMA

465

401

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IMPORTANCE Amyloid positron emission tomography (PET) detects amyloid plaques in the brain, a core neuropathological feature of Alzheimer disease. OBJECTIVE To determine if amyloid PET is associated with subsequent changes in the management of patients with mild cognitive impairment (MCI) or dementia of uncertain etiology. DESIGN, SETTING, AND PARTICIPANTS The Imaging Dementia-Evidence for Amyloid Scanning (IDEAS) study was a single-group, multisite longitudinal study that assessed the association between amyloid PET and subsequent changes in clinical management for Medicare beneficiaries with MCI or dementia. Participants were required to meet published appropriate use criteria stating that etiology of cognitive impairment was unknown, Alzheimer disease was a diagnostic consideration, and knowledge of PET results was expected to change diagnosis and management. A total of 946 dementia specialists at 595 US sites enrolled 16 008 patients between February 2016 and September 2017. Patients were followed up through January 2018. Dementia specialists documented their diagnosis and management plan before PET and again 90 (±30) days after PET. EXPOSURES Participants underwent amyloid PET at 343 imaging centers. MAIN OUTCOMES AND MEASURES The primary end point was change in management between the pre-and post-PET visits, as assessed by a composite outcome that included Alzheimer disease drug therapy, other drug therapy, and counseling about safety and future planning. The study was powered to detect a 30% or greater change in the MCI and dementia groups. One of 2 secondary end points is reported: the proportion of changes in diagnosis (from Alzheimer disease to non-Alzheimer disease and vice versa) between pre-and post-PET visits. RESULTS Among 16 008 registered participants, 11 409 (71.3%) completed study procedures and were included in the analysis (median age, 75 years [interquartile range, 71-80]; 50.9% women; 60.5% with MCI). Amyloid PET results were positive in 3817 patients with MCI (55.3%) and 3154 patients with dementia (70.1%). The composite end point changed in 4159 of 6905 patients with MCI (60.2% [95% CI, 59.1%-61.4%]) and 2859 of 4504 patients with dementia (63.5% [95% CI, 62.1%-64.9%]), significantly exceeding the 30% threshold in each group (P < .001, 1-sided). The etiologic diagnosis changed from Alzheimer disease to non-Alzheimer disease in 2860 of 11 409 patients (25.1% [95% CI, 24.3%-25.9%]) and from non-Alzheimer disease to Alzheimer disease in 1201 of 11 409 (10.5% [95% CI, 10.0%-11.1%]). CONCLUSIONS AND RELEVANCE Among Medicare beneficiaries with MCI or dementia of uncertain etiology evaluated by dementia specialists, the use of amyloid PET was associated with changes in clinical management within 90 days. Further research is needed to determine whether amyloid PET is associated with improved clinical outcomes.

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Section: Limitationssupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Association of Amyloid Positron Emission Tomography With Subsequent Change in Clinical Management Among Medicare Beneficiaries With Mild Cognitive Impairment or Dementia

Rabinovici

Gatsonis

Apgar

et al. 2019

JAMA

465

401

View full text Add to dashboard Cite

show abstract

“…The imaging biomarkers groups extended the previous consensus work, 4,63 by incorporating new research published since 2012 especially systematic reviews and meta-analyses, [64][65][66][67][68][69][70][71][72][73] and guidelines and task force documents. [74][75][76][77][78][79][80][81][82][83] We have refined our suggestions on the (Table 4).…”

Section: Use Of Neuroimaging and Fluid Biomarkersmentioning

confidence: 99%

Recommendations of the 5th Canadian Consensus Conference on the diagnosis and treatment of dementia

Ismail

Black

Camicioli

et al. 2020

Alzheimer's & Dementia

160

171

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Since 1989, four Canadian Consensus Conferences on the Diagnosis and Treatment of Dementia (CCCDTD) have provided evidence‐based dementia guidelines for Canadian clinicians and researchers. We present the results of the 5th CCCDTD, which convened in October 2019, to address topics chosen by the steering committee to reflect advances in the field, and build on previous guidelines. Topics included: (1) utility of the National Institute on Aging research framework for clinical Alzheimer's disease (AD) diagnosis; (2) updating diagnostic criteria for vascular cognitive impairment, and its management; (3) dementia case finding and detection; (4) neuroimaging and fluid biomarkers in diagnosis; (5) use of non‐cognitive markers of dementia for better dementia detection; (6) risk reduction/prevention; (7) psychosocial and non‐pharmacological interventions; and (8) deprescription of medications used to treat dementia. We hope the guidelines are useful for clinicians, researchers, policy makers, and the lay public, to inform a current and evidence‐based approach to dementia.

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“…Brain A␤ antemortem is quantifiable via radioactive labelling on positron emission tomography (PET) [6] and can also be estimated from A␤ concentrations in cerebrospinal fluid (CSF) as a molecular biomarker [7]. Amyloid PET and CSF A␤ can be used interchangeably for clinical diagnosis [7,8] and are increasingly relied upon in diagnostic frameworks [9,10].…”

Section: Introductionmentioning

confidence: 99%

“…For instance, with sufficient sensitivity and specificity, analysis of blood A␤ could serve as a first-step screening tool for selection of patients for more cost-intensive and high-risk diagnostic measures. Ultimately, blood A␤ analysis might have a comparable impact on diagnostic procedures as amyloid PET [6,17] and CSF A␤ analysis [18,19], and even more so due to a projected wider uptake.…”

Section: Introductionmentioning

confidence: 99%

Plasma Amyloid Concentration in Alzheimer’s Disease: Performance of a High-Throughput Amyloid Assay in Distinguishing Alzheimer’s Disease Cases from Controls

Feinkohl

Schipke

Kruppa

et al. 2020

JAD

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Background: Collection of cerebrospinal fluid (CSF) for measurement of amyloid-␤ (A␤) species is a gold standard in Alzheimer's disease (AD) diagnosis, but has risks. Thus, establishing a low-risk blood A␤ test with high AD sensitivity and specificity is of outmost interest. Objective: We evaluated the ability of a commercially available plasma A␤ assay to distinguish AD patients from biomarkerhealthy controls. Method: In a case-control design, we examined plasma samples from 44 AD patients (A + N+) and 49 controls (A-N-) from a memory clinic. AD was diagnosed using a combination of neuropsychological examination, CSF biomarker analysis and brain imaging. Total A␤ 40 and total A␤ 42 in plasma were measured through enzyme-linked immunosorbent assay (ELISA) technology using ABtest40 and ABtest42 test kits (Araclon Biotech Ltd.). Receiver operating characteristic (ROC) analyses with outcome AD were performed, and sensitivity and specificity were calculated.

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Impact of Amyloid PET Imaging in the Memory Clinic: A Systematic Review and Meta-Analysis

Abstract: Aβ-PET has a highly significant impact on both changes in diagnosis and management among patients being seen at a specialty memory clinic.

Cited by 32 publications

References 34 publications

Association of Amyloid Positron Emission Tomography With Subsequent Change in Clinical Management Among Medicare Beneficiaries With Mild Cognitive Impairment or Dementia

Association of Amyloid Positron Emission Tomography With Subsequent Change in Clinical Management Among Medicare Beneficiaries With Mild Cognitive Impairment or Dementia

Recommendations of the 5th Canadian Consensus Conference on the diagnosis and treatment of dementia

Plasma Amyloid Concentration in Alzheimer’s Disease: Performance of a High-Throughput Amyloid Assay in Distinguishing Alzheimer’s Disease Cases from Controls

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