Premium
[P2–397]: ASSOCIATIONS BETWEEN NORMAL VARIATION IN KIDNEY FUNCTION AND BRAIN FUNCTION IN OLDER ADULTS WITH AND WITHOUT MILD COGNITIVE IMPAIRMENT
Author(s) -
Coutinho Artur M.,
Stephens Kimberly A.,
Alvarado Rachel L.,
Greve Douglas N.,
Catana Ciprian,
Rosen Bruce R.,
Salat David H.
Publication year - 2017
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.2017.06.1052
Subject(s) - renal function , posterior cingulate , default mode network , cognition , creatinine , medicine , neuroimaging , resting state fmri , white matter , psychology , neuroscience , magnetic resonance imaging , radiology
depend upon the specific cause of cognitive impairment identified. Provider confidence in the diagnosis also affects the willingness to discuss difficult, lifechanging recommendations.Methods:We identified 8 independent, non-drug care recommendations that would be altered depending upon the cause of cognitive impairment and used them as outcomes in a study of the clinical use of amyloid PET. Amyloid PETwith 18F-flutemetamol was performed in 15 patients (9 men, 6women,meanage64.6, age range51-85)whosediagnosiswasuncertain after an otherwise complete dementia specialist evaluation. Scans were read visually, aided by quantitative analysis using Cortex ID software and classified as either positive indicating significant pathologyor negative.Weevaluated changes in physician diagnosis, diagnostic confidence and recommended care practices before and after amyloid PET imaging.Results:Significant binding in the cerebral cortex was present in 13 (87%) of the scans. In 14 patients (82%) recommended care practices changed after amyloid PET. These recommendations involved planning for likely stable or progressive disease course (33% change), monitoring for disease complications (13%), disease specific education (40%) and referrals. Scans stimulated referrals to develop a family plan of progressive support in 27% and to a psychiatrist in 20%. The most frequent change in care practices was referral to a Alzheimer clinical trial (53%). The diagnosis judged most likely before the scan changed in 27% and there was a 90% increase in diagnostic confidence after the amyloid PET. Conclusions:The classification of Alzheimer’s pathology with amyloid PET frequently changes provider recommendations that depend upon a specific diagnosis. Changes in recommended non-drug care practices contribute to the value of amyloid PET. Further experience is needed to fully understand the role of amyloid classification technology in clinical practice.