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O4‐01‐03: AMYLOID PET HAS GREATER CLINICAL IMPACT THAN FDG PET IN THE DIFFERENTIAL DIAGNOSIS OF AD AND FTD
Author(s) -
Ghosh Pia M.,
Madison Cindee,
Santos Miguel,
Norton Kristin,
Baker Suzanne,
Boxer Adam L.,
Rosen Howard J.,
Miller Zachary A.,
GornoTempini Marilu,
Miller Bruce L.,
Jagust William J.,
Rabinovici Gil D.
Publication year - 2014
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2014.04.386
Subject(s) - medicine , concordance , medical diagnosis , frontotemporal dementia , dementia , neurology , pet imaging , positron emission tomography , differential diagnosis , nuclear medicine , radiology , disease , pathology , psychiatry
Background: Appropriate use criteria (AUC) by Johnson et al, 2013, provide guidelines for selecting patients for whom amyloid PET could be most useful. The objective of this studywas to compare the impact of amyloid PETon diagnosis and management in patients likely to meet AUC compared with patients outside of AUC. Methods: This analysis was performed using data from 19 clinical sites. Treating physicians provided a provisional diagnosis and management plan for patients presenting for evaluation of cognitive decline prior to amyloid PET imagingwith florbetapir F18. Participants’ medical records for the 3 months immediately after imaging were then abstracted to capture their actual diagnosis and management, and planned diagnosis and management was compared to chart data. Participants were classified as meeting an operational definition of AUC-like or not, based on pre-scan diagnosis and demographic features. Results: Records for 172 participants were available for review. 101/172 (59%) subjects met the operational definition of AUC. The non-AUC cases included typical AD, MCI due to AD and cognitive decline with no objective impairment (CD). 47/101 (47%) AUC-like cases were amyloid positive (Ab+) compared to 44/71 (62%) of non-AUC cases. Diagnosis changed after PET scan for 58% of AUC cases vs 45% of non-AUC cases (p1⁄40.10). Similarly, the proportion of patients with change in management plan was high for both AUC (88%) and non-AUC (77%) cases. In particular, the use of AD medications including cholinesterase inhibitors or memantine declined after a negative florbetapir scan by 20% (from 26/54 to 15/54 cases; p1⁄40.002) in AUC cases and by 33% (from 17/27 to 8/27 cases; p1⁄40.004) in non-AUC cases. Diagnoses for non-AUC cases in which AD medications were withdrawn after a negative scan included prodromal AD/MCI due to AD (n1⁄48), or MCI of uncertain etiology (n1⁄41). Conclusions: The AUC criteria exclude patients with a relatively high or low probability of a positive Ab scan. PET amyloid imaging was associated with altered diagnosis and management in patients selected according to AUC. Negative PET amyloid imaging was also associated with decreased treatment with AD medications in non-AUC cases with mild or prodromal clinical syndromes.