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Clinical impact of amyloid PET using 18F-florbetapir in patients with cognitive impairment and suspected Alzheimer's disease: a multicenter study. Ann Nucl Med 2022; 36:1039-1049. [PMID: 36194355 DOI: 10.1007/s12149-022-01792-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/27/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Amyloid positron emission tomography (PET) can reliably detect senile plaques and fluorinated ligands are approved for clinical use. However, the clinical impact of amyloid PET imaging is still under investigation. The aim of this study was to evaluate the diagnostic impact and clinical utility in patient management of amyloid PET using 18F-florbetapir in patients with cognitive impairment and suspected Alzheimer's disease (AD). We also aimed to determine the cutoffs for amyloid positivity for quantitative measures by investigating the agreement between quantitative and visual assessments. METHODS Ninety-nine patients suspected of having AD underwent 18F-florbetapir PET at five institutions. Site-specialized physicians provided a diagnosis of AD or non-AD with a percentage estimate of their confidence and their plan for patient management in terms of medication, prescription dosage, additional diagnostic tests, and care planning both before and after receiving the amyloid imaging results. A PET image for each patient was visually assessed and dichotomously rated as either amyloid-positive or amyloid-negative by four board-certified nuclear medicine physicians. The PET images were also quantitatively analyzed using the standardized uptake value ratio (SUVR) and Centiloid (CL) scale. RESULTS Visual interpretation obtained 48 positive and 51 negative PET scans. The amyloid PET results changed the AD and non-AD diagnosis in 39 of 99 patients (39.3%). The change rates of 26 of the 54 patients (48.1%) with a pre-scan AD diagnosis were significantly higher than those of 13 of the 45 patients with a pre-scan non-AD diagnosis (χ2 = 5.334, p = 0.0209). Amyloid PET results also resulted in at least one change to the patient management plan in 42 patients (42%), mainly medication (20 patients, 20%) and care planning (25 patients, 25%). Receiver-operating characteristic analysis determined the best agreement of the quantitative assessments and visual interpretation of PET scans to have an area under the curve of 0.993 at an SUVR of 1.19 and CL of 25.9. CONCLUSION Amyloid PET using 18F-florbetapir PET had a substantial clinical impact on AD and non-AD diagnosis and on patient management by enhancing diagnostic confidence. In addition, the quantitative measures may improve the visual interpretation of amyloid positivity.
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2
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Wang Y, Huynh TT, Bandara N, Cho HJ, Rogers BE, Mirica LM. 2-(4-Hydroxyphenyl)benzothiazole dicarboxylate ester TACN chelators for 64Cu PET imaging in Alzheimer's disease. Dalton Trans 2022; 51:1216-1224. [PMID: 34951428 PMCID: PMC8969080 DOI: 10.1039/d1dt02767k] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Herein we report a new series of bifunctional chelators (BFCs) with high affinity for amyloid β aggregates, strong binding affinity towards Cu(II), and favorable lipophilicity for potential blood-brain barrier (BBB) penetration. The alkyl carboxylate ester pendant arms show high binding affinity towards Cu(II). The BFCs form stable 64Cu-radiolabeled complexes and exhibit favorable partition coefficient (log D) values of 0.75-0.95. Among the five compounds tested, 64Cu-YW-1 and 64Cu-YW-13 complexes exhibit significant staining of amyloid plaques in ex vivo autoradiography studies.
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Affiliation(s)
- Yujue Wang
- Department of Chemistry, University of Illinois at Urbana-Champaign, 600 S. Mathews Avenue, Urbana, Illinois 61801, United States
| | - Truc T. Huynh
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri 63108, United States, Department of Chemistry, Washington University, St. Louis, Missouri 63130, United States
| | - Nilantha Bandara
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri 63108, United States
| | - Hong-Jun Cho
- Department of Chemistry, University of Illinois at Urbana-Champaign, 600 S. Mathews Avenue, Urbana, Illinois 61801, United States
| | - Buck E. Rogers
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri 63108, United States
| | - Liviu M. Mirica
- Department of Chemistry, University of Illinois at Urbana-Champaign, 600 S. Mathews Avenue, Urbana, Illinois 61801, United States, Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO 63110, United States,Corresponding Author:
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3
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Albrechtsen SS, Riis RGC, Amiri M, Tanum G, Bergdal O, Blaabjerg M, Simonsen CZ, Kondziella D. Impact of MRI on decision-making in ICU patients with disorders of consciousness. Behav Brain Res 2021; 421:113729. [PMID: 34973968 DOI: 10.1016/j.bbr.2021.113729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 12/02/2021] [Accepted: 12/21/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Recovery of consciousness is the most important survival factor in patients with acute brain injury and disorders of consciousness (DoC). Since most deaths in the intensive care unit (ICU) occur after withdrawal of life-support, medical decision-making is crucial for acute DoC patients. Neuroimaging informs decision-making, yet the precise effects of MRI on decision-making in the ICU are poorly understood. We investigated the impact of brain MRI on prognostication, therapeutic decisions and physician confidence in ICU patients with DoC. METHODS In this simulated decision-making study utilizing a prospective ICU cohort, a panel of neurocritical experts first reviewed clinical information (without MRI) from 75 acute DoC patients and made decisions about diagnosis, prognosis and treatment. Following review of the MRI, the panel then decided if the initial decisions needed revision. In parallel, a blinded neuroradiologist reassessed all neuroimaging. RESULTS MRI led to changes in clinical management of 57 (76%) of patients (Number-Needed-to-Test for any change: 1.32), including revised diagnoses (20%), levels of care (21%), diagnostic confidence (43%) and prognostications (33%). Decisions were revised more often with stroke than with other brain injuries (p = 0.02). However, although MRI revealed additional pathology in 81%, this did not predict revised clinical decision-making (p-values ≥0.08). CONCLUSION MRI results changed decision-making in 3 of 4 ICU patients, but radiological findings were not predictive of clinical decision-making. This highlights the need to better understand the effects of neuroimaging on management decisions. How MRI influences decision-making in the ICU is an important avenue for research to improve acute DoC management.
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Affiliation(s)
- Simon S Albrechtsen
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Robert G C Riis
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Moshgan Amiri
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Gry Tanum
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Ove Bergdal
- Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Denmark
| | | | | | - Daniel Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark.
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Frederiksen KS, Nielsen TR, Winblad B, Schmidt R, Kramberger MG, Jones RW, Hort J, Grimmer T, Georges J, Frölich L, Engelborghs S, Dubois B, Waldemar G. European Academy of Neurology/European Alzheimer's Disease Consortium position statement on diagnostic disclosure, biomarker counseling, and management of patients with mild cognitive impairment. Eur J Neurol 2021; 28:2147-2155. [PMID: 33368924 PMCID: PMC8246881 DOI: 10.1111/ene.14668] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND PURPOSE Careful counseling through the diagnostic process and adequate postdiagnostic support in patients with mild cognitive impairment (MCI) is important. Previous studies have indicated heterogeneity in practice and the need for guidance for clinicians. METHODS A joint European Academy of Neurology/European Alzheimer's Disease Consortium panel of dementia specialists was appointed. Through online meetings and emails, positions were developed regarding disclosing a syndrome diagnosis of MCI, pre- and postbiomarker sampling counseling, and postdiagnostic support. RESULTS Prior to diagnostic evaluation, motives and wishes of the patient should be sought. Diagnostic disclosure should be carried out by a dementia specialist taking the ethical principles of "the right to know" versus "the wish not to know" into account. Disclosure should be accompanied by written information and a follow-up plan. It should be made clear that MCI is not dementia. Prebiomarker counseling should always be carried out if biomarker sampling is considered and postbiomarker counseling if sampling is carried out. A dementia specialist knowledgeable about biomarkers should inform about pros and cons, including alternatives, to enable an autonomous and informed decision. Postbiomarker counseling will depend in part on the results of biomarkers. Follow-up should be considered for all patients with MCI and include brain-healthy advice and possibly treatment for specific underlying causes. Advice on advance directives may be relevant. CONCLUSIONS Guidance to clinicians on various aspects of the diagnostic process in patients with MCI is presented here as position statements. Further studies are needed to enable more evidence-based and standardized recommendations in the future.
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Affiliation(s)
| | - T. Rune Nielsen
- Department of NeurologyDanish Dementia Research CentreRigshospitaletCopenhagenDenmark
| | - Bengt Winblad
- Division of NeurogeriatricsDepartment of Neurobiology, Care Sciences and SocietyCenter for Alzheimer ResearchKarolinska InstituteSolnaSweden
- Theme AgingKarolinska University HospitalStockholmSweden
| | | | - Milica G. Kramberger
- Department of NeurologyCenter for Cognitive ImpairmentsUniversity Medical CentreLjubljanaSlovenia
| | - Roy W. Jones
- RICE (The Research Institute for the Care of Older People)Royal United HospitalBath and University of BristolBristolUK
| | - Jakub Hort
- Department of NeurologyCognitive CenterSecond Faculty of Medicine and Motol University HospitalCharles UniversityPragueCzech Republic
| | - Timo Grimmer
- Department of Psychiatry and PsychotherapySchool of MedicineRechts der Isar HospitalTechnical University of MunichMunichGermany
| | | | - Lutz Frölich
- Department of Geriatric PsychiatryUniversity of HeidelbergMannheimGermany
| | - Sebastiaan Engelborghs
- Department of Neurology and Center for NeurosciencesUZ Brussel and Free University of Brussels (VUBBrusselsBelgium
- Reference Center for Biological Markers of Dementia (BIODEM)Institute Born‐BungeUniversity of AntwerpAntwerpBelgium
| | - Bruno Dubois
- Department of NeurologyDementia Research CenterSalpêtrière HospitalSorbonne UniversityParisFrance
| | - Gunhild Waldemar
- Department of NeurologyDanish Dementia Research CentreRigshospitaletCopenhagenDenmark
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Damian A, Portugal F, Niell N, Quagliata A, Bayardo K, Alonso O, Ferrando R. Clinical Impact of PET With 18F-FDG and 11C-PIB in Patients With Dementia in a Developing Country. Front Neurol 2021; 12:630958. [PMID: 34017300 PMCID: PMC8129494 DOI: 10.3389/fneur.2021.630958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 04/06/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction: The objective of this study was to evaluate the clinical impact PET with 18F-FDG and 11C-PIB in patients with dementia in a developing country. Methodology: Retrospective study of the patients referred for the evaluation of dementia to the only PET center in Uruguay. A total of 248 patients were identified, from which 70 patients were included based on the availability of medical history and clinical follow-up. Main outcomes included change in diagnosis, diagnostic dilemma and AD treatment. We evaluated the association of clinical outcomes with PET concordance with baseline diagnosis, diagnostic dilemma, level of education, AD pathology/Non-AD pathology (AD/Non-AD), baseline diagnosis and 11C-PIB PET result. Results: Baseline clinical diagnosis was concordant with 18F-FDG and 11C-PIB PET results in 64.7 and 77.1% of the patients, respectively. Change in diagnosis after PET was identified in 30.0% of the patients and was associated with discordant 18F-FDG (p = 0.002) and 11C-PIB (p < 0.001) PET results, previous diagnostic dilemma (p = 0.005), low education (p = 0.027), Non-AD baseline diagnosis (p = 0.027), and negative 11C-PIB PET result (p < 0.001). Only the last variable remained significant in the multivariate analysis (adjusted p = 0.038). Diagnostic dilemma decreased after PET from 15.7 to 7.1% (p = 0.11) and was associated with Non-AD diagnosis (p = 0.002) and negative 11C-PIB PET result (p = 0.003). Change in AD treatment after PET occurred in 45.7% of the patients. Conclusion:18F-FDG and 11C-PIB PET had a significant clinical impact in terms of change in diagnosis and treatment in patients with dementia in a developing country, similar to that reported in high-income countries.
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Affiliation(s)
- Andres Damian
- Centro Uruguayo de Imagenología Molecular (CUDIM), Montevideo, Uruguay.,Centro de Medicina Nuclear e Imagenología Molecular, Hospital de Clínicas, Universidad de la República (UdelaR), Montevideo, Uruguay
| | - Fabiola Portugal
- Centro de Medicina Nuclear e Imagenología Molecular, Hospital de Clínicas, Universidad de la República (UdelaR), Montevideo, Uruguay
| | - Nicolas Niell
- Centro Uruguayo de Imagenología Molecular (CUDIM), Montevideo, Uruguay.,Centro de Medicina Nuclear e Imagenología Molecular, Hospital de Clínicas, Universidad de la República (UdelaR), Montevideo, Uruguay
| | - Adriana Quagliata
- Centro Uruguayo de Imagenología Molecular (CUDIM), Montevideo, Uruguay
| | - Karina Bayardo
- Centro de Medicina Nuclear e Imagenología Molecular, Hospital de Clínicas, Universidad de la República (UdelaR), Montevideo, Uruguay
| | - Omar Alonso
- Centro Uruguayo de Imagenología Molecular (CUDIM), Montevideo, Uruguay.,Centro de Medicina Nuclear e Imagenología Molecular, Hospital de Clínicas, Universidad de la República (UdelaR), Montevideo, Uruguay
| | - Rodolfo Ferrando
- Centro Uruguayo de Imagenología Molecular (CUDIM), Montevideo, Uruguay.,Centro de Medicina Nuclear e Imagenología Molecular, Hospital de Clínicas, Universidad de la República (UdelaR), Montevideo, Uruguay
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Outcomes of clinical utility in amyloid-PET studies: state of art and future perspectives. Eur J Nucl Med Mol Imaging 2021; 48:2157-2168. [PMID: 33594474 PMCID: PMC8175294 DOI: 10.1007/s00259-020-05187-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/28/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE To review how outcomes of clinical utility are operationalized in current amyloid-PET validation studies, to prepare for formal assessment of clinical utility of amyloid-PET-based diagnosis. METHODS Systematic review of amyloid-PET research studies published up to April 2020 that included outcomes of clinical utility. We extracted and analyzed (a) outcome categories, (b) their definition, and (c) their methods of assessment. RESULTS Thirty-two studies were eligible. (a) Outcome categories were clinician-centered (found in 25/32 studies, 78%), patient-/caregiver-centered (in 9/32 studies, 28%), and health economics-centered (5/32, 16%). (b) Definition: Outcomes were mainly defined by clinical researchers; only the ABIDE study expressly included stakeholders in group discussions. Clinician-centered outcomes mainly consisted of incremental diagnostic value (25/32, 78%) and change in patient management (17/32, 53%); patient-/caregiver-centered outcomes considered distress after amyloid-pet-based diagnosis disclosure (8/32, 25%), including quantified burden of procedure for patients' outcomes (n = 8) (1/8, 12.5%), impact of disclosure of results (6/8, 75%), and psychological implications of biomarker-based diagnosis (75%); and health economics outcomes focused on costs to achieve a high-confidence etiological diagnosis (5/32, 16%) and impact on quality of life (1/32, 3%). (c) Assessment: all outcome categories were operationalized inconsistently across studies, employing 26 different tools without formal rationale for selection. CONCLUSION Current studies validating amyloid-PET already assessed outcomes for clinical utility, although non-clinician-based outcomes were inconsistent. A wider participation of stakeholders may help produce a more thorough and systematic definition and assessment of outcomes of clinical utility and help collect evidence informing decisions on reimbursement of amyloid-PET.
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Kolanko MA, Win Z, Loreto F, Patel N, Carswell C, Gontsarova A, Perry RJ, Malhotra PA. Amyloid PET imaging in clinical practice. Pract Neurol 2020; 20:451-462. [PMID: 32973035 DOI: 10.1136/practneurol-2019-002468] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2020] [Indexed: 02/07/2023]
Abstract
Amyloid positron emission tomography (PET) imaging enables in vivo detection of brain Aβ deposition, one of the neuropathological hallmarks of Alzheimer's disease. There is increasing evidence to support its clinical utility, with major studies showing that amyloid PET imaging improves diagnostic accuracy, increases diagnostic certainty and results in therapeutic changes. The Amyloid Imaging Taskforce has developed appropriate use criteria to guide clinicians by predefining certain scenarios where amyloid PET would be justified. This review provides a practical guide on how and when to use amyloid PET, based on the available research and our own experience. We discuss its three main appropriate indications and illustrate these with clinical cases. We stress the importance of a multidisciplinary approach when deciding who might benefit from amyloid PET imaging. Finally, we highlight some practical points and common pitfalls in its interpretation.
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Affiliation(s)
- Magdalena A Kolanko
- Department of Brain Sciences, Imperial College London, London, UK.,Department of Clinical Neurosciences, Imperial College Healthcare NHS Trust, London, UK
| | - Zarni Win
- Department of Nuclear Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Flavia Loreto
- Department of Brain Sciences, Imperial College London, London, UK
| | - Neva Patel
- Department of Nuclear Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Christopher Carswell
- Department of Clinical Neurosciences, Imperial College Healthcare NHS Trust, London, UK.,Department of Neurology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Richard J Perry
- Department of Brain Sciences, Imperial College London, London, UK.,Department of Clinical Neurosciences, Imperial College Healthcare NHS Trust, London, UK
| | - Paresh A Malhotra
- Department of Brain Sciences, Imperial College London, London, UK .,Department of Clinical Neurosciences, Imperial College Healthcare NHS Trust, London, UK.,UK Dementia Research Institute Care Research and Technology Centre, Imperial College London and the University of Surrey, UK
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8
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Prosser A, Tossici-Bolt L, Kipps C. The impact of regional 99mTc-HMPAO single-photon-emission computed tomography (SPECT) imaging on clinician diagnostic confidence in a mixed cognitive impairment sample. Clin Radiol 2020; 75:714.e7-714.e14. [DOI: 10.1016/j.crad.2020.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/28/2020] [Indexed: 11/17/2022]
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9
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Spallazzi M, Barocco F, Michelini G, Morelli N, Scarlattei M, Baldari G, Ruffini L, Caffarra P. The Incremental Diagnostic Value of [18F]Florbetaben PET and the Pivotal Role of the Neuropsychological Assessment in Clinical Practice. J Alzheimers Dis 2020; 67:1235-1244. [PMID: 30689568 DOI: 10.3233/jad-180646] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Amyloid pathology is a key feature of Alzheimer's disease (AD) and can be assessed in vivo with amyloid positron emission tomography (PET) imaging. OBJECTIVE The objective of this study was to evaluate the incremental value of a PET scan with [18F]florbetaben, in terms of changes of diagnosis, diagnostic confidence, and treatment plan when added to a standardized diagnostic workup for cognitive disorders, with particular focus on the role of the neuropsychological assessment, including the Free and Cued Selective Reminding Test (FCSRT). METHODS A total of 104 patients (69 mild cognitive impairment, 35 dementia), with diagnostic uncertainty after diagnostic workup, were recruited from our memory clinic. [18F]florbetaben PET scans were interpreted as amyloid negative or positive on the basis of a semi-quantitative visual rating. Clinical diagnosis and diagnostic confidence for AD or non-AD dementia were rated before and after PET result disclosure, as was the impact of PET on the patient management plan. RESULTS There were 69/104 (66%) [18F]florbetaben positive scans, 51/62 (82%) patients were suspected as having AD before the PET scan and 18/42 (43%) were not. Overall, the data obtained at PET changed 18/104 diagnoses (17%) and increased diagnostic confidence from 69.1±8.1% to 83.5±9.1 (p < 0.001), with the greatest impact on diagnosis and confidence in PET negative patients with an initial diagnosis of AD (p < 0.01) and in early-onset patients (p = 0.01). CONCLUSION Amyloid PET represents a source of added value in dementia diagnosis, with a significant effect on diagnosis and diagnostic confidence. However, the use of a complete neuropsychological assessment has an add-on value on limiting the amyloid PET influence on change of diagnosis, and the real impact of amyloid PET should always be weighed up together with an accurate standardized diagnostic workup.
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Affiliation(s)
- Marco Spallazzi
- Department of Neurology, G. da Saliceto Hospital, Piacenza, Italy
| | | | | | - Nicola Morelli
- Department of Neurology, G. da Saliceto Hospital, Piacenza, Italy
| | - Maura Scarlattei
- Department of Nuclear Medicine, Azienda Ospedaliero-Universitaria, Parma, Italy
| | - Giorgio Baldari
- Department of Nuclear Medicine, Azienda Ospedaliero-Universitaria, Parma, Italy
| | - Livia Ruffini
- Department of Nuclear Medicine, Azienda Ospedaliero-Universitaria, Parma, Italy
| | - Paolo Caffarra
- Alzheimer Center, Briolini Hospital, Gazzaniga, Bergamo, Italy.,Department of Medicine and Surgery, Section of Neuroscience, University of Parma, Parma, Italy
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Boccardi M, Nicolosi V, Festari C, Bianchetti A, Cappa S, Chiasserini D, Falini A, Guerra UP, Nobili F, Padovani A, Sancesario G, Morbelli S, Parnetti L, Tiraboschi P, Muscio C, Perani D, Pizzini FB, Beltramello A, Salvini Porro G, Ciaccio M, Schillaci O, Trabucchi M, Tagliavini F, Frisoni GB. Italian consensus recommendations for a biomarker-based aetiological diagnosis in mild cognitive impairment patients. Eur J Neurol 2019; 27:475-483. [PMID: 31692118 DOI: 10.1111/ene.14117] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 11/04/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Biomarkers support the aetiological diagnosis of neurocognitive disorders in vivo. Incomplete evidence is available to drive clinical decisions; available diagnostic algorithms are generic and not very helpful in clinical practice. The aim was to develop a biomarker-based diagnostic algorithm for mild cognitive impairment patients, leveraging on knowledge from recognized national experts. METHODS With a Delphi procedure, experienced clinicians making variable use of biomarkers in clinical practice and representing five Italian scientific societies (neurology - Società Italiana di Neurologia per le Demenze; neuroradiology - Associazione Italiana di Neuroradiologia; biochemistry - Società Italiana di Biochimica Clinica; psychogeriatrics - Associazione Italiana di Psicogeriatria; nuclear medicine - Associazione Italiana di Medicina Nucleare) defined the theoretical framework, relevant literature, the diagnostic issues to be addressed and the diagnostic algorithm. An N-1 majority defined consensus achievement. RESULTS The panellists chose the 2011 National Institute on Aging and Alzheimer's Association diagnostic criteria as the reference theoretical framework and defined the algorithm in seven Delphi rounds. The algorithm includes baseline clinical and cognitive assessment, blood examination, and magnetic resonance imaging with exclusionary and inclusionary roles; dopamine transporter single-photon emission computed tomography (if no/unclear parkinsonism) or metaiodobenzylguanidine cardiac scintigraphy for suspected dementia with Lewy bodies with clear parkinsonism (round VII, votes (yes-no-abstained): 3-1-1); 18 F-fluorodeoxyglucose positron emission tomography for suspected frontotemporal lobar degeneration and low diagnostic confidence of Alzheimer's disease (round VII, 4-0-1); cerebrospinal fluid for suspected Alzheimer's disease (round IV, 4-1-0); and amyloid positron emission tomography if cerebrospinal fluid was not possible/accepted (round V, 4-1-0) or inconclusive (round VI, 5-0-0). CONCLUSIONS These consensus recommendations can guide clinicians in the biomarker-based aetiological diagnosis of mild cognitive impairment, whilst guidelines cannot be defined with evidence-to-decision procedures due to incomplete evidence.
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Affiliation(s)
- M Boccardi
- IRCCS Istituto Centro S.Giovanni di Dio-Fatebenefratelli, Brescia, Italy.,University of Geneva, Geneva, Switzerland
| | - V Nicolosi
- IRCCS Istituto Centro S.Giovanni di Dio-Fatebenefratelli, Brescia, Italy
| | - C Festari
- IRCCS Istituto Centro S.Giovanni di Dio-Fatebenefratelli, Brescia, Italy.,University of Brescia, Brescia, Italy
| | - A Bianchetti
- Istituto Clinico S. Anna, Brescia, Italy.,Italian Psychogeriatric Association (AIP), Brescia, Italy
| | - S Cappa
- IRCCS Istituto Centro S.Giovanni di Dio-Fatebenefratelli, Brescia, Italy.,University Institute of Higher Studies, Pavia, Italy.,Italian Society of Neurology for the Study of the Dementias (SINdem), Milan, Italy
| | - D Chiasserini
- University of Perugia, Perugia, Italy.,Italian Society of Clinical Biochemistry and Clinical Molecular Biology - Laboratory Medicine (SIBioC), Rimini, Italy
| | - A Falini
- IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy.,Italian Association of Neuroradiology (AINR), Milan, Italy
| | - U P Guerra
- Poliambulanza Foundation, Brescia, Italy.,Italian Association of Nuclear Medicine (AIMN), Bari, Italy
| | - F Nobili
- Italian Association of Nuclear Medicine (AIMN), Bari, Italy.,University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - A Padovani
- Italian Society of Neurology for the Study of the Dementias (SINdem), Milan, Italy.,Brescia University Hospital, Brescia, Italy
| | - G Sancesario
- Italian Society of Clinical Biochemistry and Clinical Molecular Biology - Laboratory Medicine (SIBioC), Rimini, Italy.,IRCCS Santa Lucia Foundation, Neuroimmunology Unit Via Ardeatina 354, Rome, Italy
| | - S Morbelli
- University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - L Parnetti
- Ospedale S. Maria della Misericordia, University of Perugia, Perugia, Italy
| | | | - C Muscio
- IRCCS 'Carlo Besta', Milan, Italy
| | - D Perani
- IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | | | - A Beltramello
- Verona University Hospital, Verona, Italy.,IRCCS 'Sacro Cuore-Don Calabria', Negrar, Verona, Italy
| | | | - M Ciaccio
- Italian Society of Clinical Biochemistry and Clinical Molecular Biology - Laboratory Medicine (SIBioC), Rimini, Italy.,University of Palermo, Palermo, Italy
| | - O Schillaci
- University Tor Vergata, Rome, Italy.,IRCCS-Neuromed, Pozzilli, Italy
| | - M Trabucchi
- Italian Psychogeriatric Association (AIP), Brescia, Italy.,University Tor Vergata, Rome, Italy
| | | | - G B Frisoni
- IRCCS Istituto Centro S.Giovanni di Dio-Fatebenefratelli, Brescia, Italy.,University of Geneva, Geneva, Switzerland
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11
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Shea YF, Barker W, Greig-Gusto MT, Loewenstein DA, DeKosky ST, Duara R. Utility of Amyloid PET Scans in the Evaluation of Patients Presenting with Diverse Cognitive Complaints. J Alzheimers Dis 2019; 66:1599-1608. [PMID: 30475766 DOI: 10.3233/jad-180683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The impact of amyloid positron emission tomography (Aβ-PET) in a "real-world" memory disorders clinic remains poorly studied. OBJECTIVE We studied the impact of Aβ-PET in diagnosis and management in the memory clinic and factors making the most impact in diagnosis and management. METHODS We studied 102 patients who had presented at a memory disorders clinic (the Wien Center for Alzheimer's Disease and Memory Disorders, Miami Beach, FL) and had a diagnostic work-up for cognitive complaints, including Aβ-PET scans. RESULTS Following Aβ-PET, changes were made in diagnosis (37.3%), in specific treatments for Alzheimer's disease (26.5%) and in psychiatric treatments (25.5%). The agreement between diagnosis pre-Aβ-PET versus post-Aβ-PET diagnosis was only fair, with a Cohen's kappa of 0.23 (95% CI 0-0.42). Patients with MRI findings suggestive of AD (medial temporal and/or parietal atrophy) were more frequently amyloid positive than amyloid negative (66.2% versus 33.8%, p = 0.04). Among patients with atypical clinical features for AD, but with MRI findings suggestive of AD, an amyloid negative PET scan had a greater impact than an amyloid positive PET scan on diagnosis (84.2% versus 17.1%, p < 0.001), management (84.2% versus 40%, p < 0.01) and discussion of results and advice on lifestyle (73.7% versus 22.9%, p < 0.001). CONCLUSIONS We conclude that MRI features suggestive of AD predict a positive amyloid PET scan. However, among those with MRI features suggestive of AD but with atypical clinical features of AD, the clinical impact on diagnosis and management is greater for an amyloid negative than an amyloid positive Aβ-PET scans.
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Affiliation(s)
- Yat-Fung Shea
- Wien Center for Alzheimer's Disease & Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL, USA.,Department of Medicine, LKS Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Warren Barker
- Wien Center for Alzheimer's Disease & Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Maria T Greig-Gusto
- Wien Center for Alzheimer's Disease & Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - David A Loewenstein
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, FL, USA
| | - Steven T DeKosky
- Department of Neurology, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Ranjan Duara
- Wien Center for Alzheimer's Disease & Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL, USA
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12
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de Wilde A, van der Flier WM, Pelkmans W, Bouwman F, Verwer J, Groot C, van Buchem MM, Zwan M, Ossenkoppele R, Yaqub M, Kunneman M, Smets EMA, Barkhof F, Lammertsma AA, Stephens A, van Lier E, Biessels GJ, van Berckel BN, Scheltens P. Association of Amyloid Positron Emission Tomography With Changes in Diagnosis and Patient Treatment in an Unselected Memory Clinic Cohort: The ABIDE Project. JAMA Neurol 2019; 75:1062-1070. [PMID: 29889941 DOI: 10.1001/jamaneurol.2018.1346] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Previous studies have evaluated the diagnostic effect of amyloid positron emission tomography (PET) in selected research cohorts. However, these research populations do not reflect daily practice, thus hampering clinical implementation of amyloid imaging. Objective To evaluate the association of amyloid PET with changes in diagnosis, diagnostic confidence, treatment, and patients' experiences in an unselected memory clinic cohort. Design, Setting, and Participants Amyloid PET using fluoride-18 florbetaben was offered to 866 patients who visited the tertiary memory clinic at the VU University Medical Center between January 2015 and December 2016 as part of their routine diagnostic dementia workup. Of these patients, 476 (55%) were included, 32 (4%) were excluded, and 358 (41%) did not participate. To enrich this sample, 31 patients with mild cognitive impairment from the University Medical Center Utrecht memory clinic were included. For each patient, neurologists determined a preamyloid and postamyloid PET diagnosis that existed of both a clinical syndrome (dementia, mild cognitive impairment, or subjective cognitive decline) and a suspected etiology (Alzheimer disease [AD] or non-AD), with a confidence level ranging from 0% to 100%. In addition, the neurologist determined patient treatment in terms of ancillary investigations, medication, and care. Each patient received a clinical follow-up 1 year after being scanned. Main Outcomes and Measures Primary outcome measures were post-PET changes in diagnosis, diagnostic confidence, and patient treatment. Results Of the 507 patients (mean [SD] age, 65 (8) years; 201 women [39%]; mean [SD] Mini-Mental State Examination score, 25 [4]), 164 (32%) had AD dementia, 70 (14%) non-AD dementia, 114 (23%) mild cognitive impairment, and 159 (31%) subjective cognitive decline. Amyloid PET results were positive for 242 patients (48%). The suspected etiology changed for 125 patients (25%) after undergoing amyloid PET, more often due to a negative (82 of 265 [31%]) than a positive (43 of 242 [18%]) PET result (P < .01). Post-PET changes in suspected etiology occurred more frequently in patients older (>65 years) than younger (<65 years) than the typical age at onset of 65 years (74 of 257 [29%] vs 51 of 250 [20%]; P < .05). Mean diagnostic confidence (SD) increased from 80 (13) to 89 (13%) (P < .001). In 123 patients (24%), there was a change in patient treatment post-PET, mostly related to additional investigations and therapy. Conclusions and Relevance This prospective diagnostic study provides a bridge between validating amyloid PET in a research setting and implementing this diagnostic tool in daily clinical practice. Both amyloid-positive and amyloid-negative results had substantial associations with changes in diagnosis and treatment, both in patients with and without dementia.
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Affiliation(s)
- Arno de Wilde
- Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | - Wiesje M van der Flier
- Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands.,Department of Epidemiology & Biostatistics, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | - Wiesje Pelkmans
- Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | - Femke Bouwman
- Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | - Jurre Verwer
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Colin Groot
- Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | - Marieke M van Buchem
- Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | - Marissa Zwan
- Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | - Rik Ossenkoppele
- Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands.,Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | - Maqsood Yaqub
- Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | - Marleen Kunneman
- Department of Medical Psychology, Amsterdam Neuroscience, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam Neuroscience, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Frederik Barkhof
- Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands.,Institutes of Neurology and Healthcare Engineering, University College London, London, England
| | - Adriaan A Lammertsma
- Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | | | | | - Geert Jan Biessels
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Bart N van Berckel
- Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands.,Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | - Philip Scheltens
- Department of Neurology & Alzheimer Center, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
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13
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Guzman-Martinez L, Maccioni RB, Farías GA, Fuentes P, Navarrete LP. Biomarkers for Alzheimer’s Disease. Curr Alzheimer Res 2019; 16:518-528. [DOI: 10.2174/1567205016666190517121140] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 04/08/2019] [Accepted: 04/25/2019] [Indexed: 12/15/2022]
Abstract
Alzheimer´s disease (AD) and related forms of dementia are increasingly affecting the aging population throughout the world, at an alarming rate. The World Alzheimer´s Report indicates a prevalence of 46.8 million people affected by AD worldwide. As population ages, this number is projected to triple by 2050 unless effective interventions are developed and implemented. Urgent efforts are required for an early detection of this disease. The ultimate goal is the identification of viable targets for the development of molecular markers and validation of their use for early diagnosis of AD that may improve treatment and the disease outcome in patients. The diagnosis of AD has been difficult to resolve since approaches for early and accurate detection and follow-up of AD patients at the clinical level have been reported only recently. Some proposed AD biomarkers include the detection of pathophysiological processes in the brain in vivo with new imaging techniques and novel PET ligands, and the determination of pathogenic proteins in cerebrospinal fluid showing anomalous levels of hyperphosphorylated tau and low Aβ peptide. These biomarkers have been increasingly accepted by AD diagnostic criteria and are important tools for the design of clinical trials, but difficulties in accessibility to costly and invasive procedures have not been completely addressed in clinical settings. New biomarkers are currently being developed to allow determinations of multiple pathological processes including neuroinflammation, synaptic dysfunction, metabolic impairment, protein aggregation and neurodegeneration. Highly specific and sensitive blood biomarkers, using less-invasive procedures to detect AD, are derived from the discoveries of peripheric tau oligomers and amyloid variants in human plasma and platelets. We have also developed a blood tau biomarker that correlates with a cognitive decline and also with neuroimaging determinations of brain atrophy.
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14
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Shea YF, Barker W, Greig-Gusto MT, Loewenstein DA, Duara R, DeKosky ST. Impact of Amyloid PET Imaging in the Memory Clinic: A Systematic Review and Meta-Analysis. J Alzheimers Dis 2019; 64:323-335. [PMID: 29889075 DOI: 10.3233/jad-180239] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients with cognitive impairment or dementias of uncertain etiology are frequently referred to a memory disorders specialty clinic. The impact of and role for amyloid PET imaging (Aβ-PET) may be most appropriate in this clinical setting. OBJECTIVE The primary objective of this study was to perform a systematic review and meta-analysis of the impact of Aβ-PET on etiological diagnosis and clinical management in the memory clinic setting. METHODS A search of the literature on the impact of Aβ-PET in the memory clinic setting between 1 January 2004 and 12 February 2018 was conducted. Meta-analysis using a random effects model was performed to determine the pooled estimate of the impact of Aβ-PET in the changes of diagnoses and changes in management plan. RESULTS After rigorous review, results from 13 studies were extracted, involving 1,489 patients. Meta-analysis revealed a pooled effect of change in diagnoses of 35.2% (95% CI 24.6-47.5). Sub-analyses showed that the pooled effect in change in diagnoses if Aβ-PET was used under the appropriate use criteria (AUC) or non-AUC criteria were 47.8% (95% CI 25.9-70.5) and 29.6% (95% CI: 21.5-39.3), respectively. The pooled effect of a change of diagnosis from Alzheimer's disease (AD) to non-AD and from non-AD to AD were 22.7% (95% CI: 17.1-29.5) and 25.6% (95% CI: 17.6-35.8), respectively. The pooled effect leading to a change of management was 59.6% (95% CI 39.4-77.0). CONCLUSIONS Aβ-PET has a highly significant impact on both changes in diagnosis and management among patients being seen at a specialty memory clinic.
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Affiliation(s)
- Yat-Fung Shea
- Wien Center for Alzheimer's Disease and Memory Disorder, Mount Sinai Medical Center, Miami Beach, FL, USA.,Department of Medicine, LKS Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Warren Barker
- Wien Center for Alzheimer's Disease and Memory Disorder, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Maria T Greig-Gusto
- Wien Center for Alzheimer's Disease and Memory Disorder, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - David A Loewenstein
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, FL, USA
| | - Ranjan Duara
- Wien Center for Alzheimer's Disease and Memory Disorder, Mount Sinai Medical Center, Miami Beach, FL, USA.,Departments of Neurology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL and University of Florida College of Medicine, Gainesville, FL, USA
| | - Steven T DeKosky
- Department of Neurology, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
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15
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Lage C, Suarez AG, Pozueta A, Riancho J, Kazimierczak M, Bravo M, Jimenez Bonilla J, de Arcocha Torres M, Quirce R, Banzo I, Vazquez-Higuera JL, Rabinovici GD, Rodriguez-Rodriguez E, Sánchez-Juan P. Utility of Amyloid and FDG-PET in Clinical Practice: Differences Between Secondary and Tertiary Care Memory Units. J Alzheimers Dis 2019; 63:1025-1033. [PMID: 29710706 DOI: 10.3233/jad-170985] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The clinical utility of amyloid positron emission tomography (PET) has not been fully established. Our aim was to evaluate the effect of amyloid imaging on clinical decision making in a secondary care unit and compare our results with a previous study in a tertiary center following the same methods. We reviewed retrospectively 151 cognitively impaired patients who underwent amyloid (Pittsburgh compound B [PiB]) PET and were evaluated clinically before and after the scan in a secondary care unit. One hundred and fifty concurrently underwent fluorodeoxyglucose (FDG)-PET. We assessed changes between the pre- and post-PET clinical diagnosis and Alzheimer's disease treatment plan. The association between PiB/FDG results and changes in management was evaluated using χ2 and multivariate logistic regression. Concordance between classification based on scan readings and baseline diagnosis was 66% for PiB and 47% for FDG. The primary diagnosis changed after PET in 17.2% of cases. When examined independently, discordant PiB and discordant FDG were both associated with diagnostic change (p < 0.0001). However, when examined together in a multivariate logistic regression, only discordant PiB remained significant (p = 0.0002). Changes in treatment were associated with concordant PiB (p = 0.009) while FDG had no effect on treatment decisions. Based on our regression model, patients with diagnostic dilemmas, a suspected non-amyloid syndrome, and Clinical Dementia Rating <1 were more likely to benefit from amyloid PET due to a higher likelihood of diagnostic change. We found that changes in diagnosis after PET in our secondary center almost doubled those of our previous analysis of a tertiary unit (9% versus 17.2%). Our results offer some clues about the rational use of amyloid PET in a secondary care memory unit stressing its utility in mild cognitive impairment patients.
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Affiliation(s)
- Carmen Lage
- Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 'Marqués de Valdecilla' University Hospital, University of Cantabria, Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
| | - Andrea Gonzalez Suarez
- Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 'Marqués de Valdecilla' University Hospital, University of Cantabria, Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
| | - Ana Pozueta
- Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 'Marqués de Valdecilla' University Hospital, University of Cantabria, Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
| | - Javier Riancho
- Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 'Marqués de Valdecilla' University Hospital, University of Cantabria, Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
| | - Martha Kazimierczak
- Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 'Marqués de Valdecilla' University Hospital, University of Cantabria, Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
| | - Maria Bravo
- Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 'Marqués de Valdecilla' University Hospital, University of Cantabria, Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
| | - Julio Jimenez Bonilla
- Department of Nuclear Medicine, University Hospital Marqués de Valdecilla, University of Cantabria, Molecular Imaging Group - IDIVAL, Santander, Spain
| | - Marıa de Arcocha Torres
- Department of Nuclear Medicine, University Hospital Marqués de Valdecilla, University of Cantabria, Molecular Imaging Group - IDIVAL, Santander, Spain
| | - Remedios Quirce
- Department of Nuclear Medicine, University Hospital Marqués de Valdecilla, University of Cantabria, Molecular Imaging Group - IDIVAL, Santander, Spain
| | - Ignacio Banzo
- Department of Nuclear Medicine, University Hospital Marqués de Valdecilla, University of Cantabria, Molecular Imaging Group - IDIVAL, Santander, Spain
| | - Jose Luis Vazquez-Higuera
- Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 'Marqués de Valdecilla' University Hospital, University of Cantabria, Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
| | - Gil D Rabinovici
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, USA; Molecular Biophysics and Integrated Bioimaging, Lawrence Berkeley National Lab, Berkeley, CA, USA; Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Eloy Rodriguez-Rodriguez
- Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 'Marqués de Valdecilla' University Hospital, University of Cantabria, Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
| | - Pascual Sánchez-Juan
- Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 'Marqués de Valdecilla' University Hospital, University of Cantabria, Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
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16
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Kim Y, Rosenberg P, Oh E. A Review of Diagnostic Impact of Amyloid Positron Emission Tomography Imaging in Clinical Practice. Dement Geriatr Cogn Disord 2019; 46:154-167. [PMID: 30199882 DOI: 10.1159/000492151] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/15/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Molecular imaging of brain amyloid for the diagnosis of Alzheimer's disease (AD) using positron emission tomography (PET) has been approved for use in clinical practice by the Food and Drug Administration (FDA) since 2012. However, the clinical utility and diagnostic impact of amyloid PET imaging remain controversial. We conducted a review of the recent studies investigating clinical utility of amyloid PET imaging with focus on changes in diagnosis, diagnostic confidence, and patient management. SUMMARY A total of 16 studies were included in the final analysis. Overall rate of changes in diagnosis after amyloid PET ranged from 9 to 68% (pooled estimate of 31%, 95% CI 23-39%). All studies reported overall increase in diagnostic confidence or diagnostic certainty after amyloid PET. Changes in patient management ranged from 37 to 87%; the most common type of change in management reported was either the initiation or discontinuation of planned AD medications. Key Messages: Amyloid PET imaging led to moderate to significant changes in diagnosis, diagnostic confidence, and subsequent patient management. It may be most useful in patients with high level of diagnostic uncertainty even after the completing the standard workup.
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Affiliation(s)
- Yejin Kim
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Paul Rosenberg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Esther Oh
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, .,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, .,Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland,
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17
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Frisoni GB, Barkhof F, Altomare D, Berkhof J, Boccardi M, Canzoneri E, Collij L, Drzezga A, Farrar G, Garibotto V, Gismondi R, Gispert JD, Jessen F, Kivipelto M, Lopes Alves I, Molinuevo JL, Nordberg A, Payoux P, Ritchie C, Savicheva I, Scheltens P, Schmidt ME, Schott JM, Stephens A, van Berckel B, Vellas B, Walker Z, Raffa N. AMYPAD Diagnostic and Patient Management Study: Rationale and design. Alzheimers Dement 2018; 15:388-399. [PMID: 30339801 DOI: 10.1016/j.jalz.2018.09.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 08/27/2018] [Accepted: 09/06/2018] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Reimbursement of amyloid-positron emission tomography (PET) is lagging due to the lack of definitive evidence on its clinical utility and cost-effectiveness. The Amyloid Imaging to Prevent Alzheimer's Disease-Diagnostic and Patient Management Study (AMYPAD-DPMS) is designed to fill this gap. METHODS AMYPAD-DPMS is a phase 4, multicenter, prospective, randomized controlled study. Nine hundred patients with subjective cognitive decline plus, mild cognitive impairment, and dementia possibly due to Alzheimer's disease will be randomized to ARM1, amyloid-PET performed early in the diagnostic workup; ARM2, amyloid-PET performed after 8 months; and ARM3, amyloid-PET performed whenever the physician chooses to do so. ENDPOINTS The primary endpoint is the difference between ARM1 and ARM2 in the proportion of patients receiving a very-high-confidence etiologic diagnosis after 3 months. Secondary endpoints address diagnosis and diagnostic confidence, diagnostic/therapeutic management, health economics and patient-related outcomes, and methods for image quantitation. EXPECTED IMPACTS AMYPAD-DPMS will supply physicians and health care payers with real-world data to plan management decisions.
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Affiliation(s)
- Giovanni B Frisoni
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland; Memory Clinic, University Hospital of Geneva, Geneva, Switzerland; Laboratory of Alzheimer's Neuroimaging and Epidemiology (LANE), Saint John of God Clinical Research Centre, Brescia, Italy.
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands; Institutes of Neurology and Healthcare Engineering, UCL, London, United Kingdom
| | - Daniele Altomare
- Laboratory of Alzheimer's Neuroimaging and Epidemiology (LANE), Saint John of God Clinical Research Centre, Brescia, Italy; Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Johannes Berkhof
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - Marina Boccardi
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland; Laboratory of Alzheimer's Neuroimaging and Epidemiology (LANE), Saint John of God Clinical Research Centre, Brescia, Italy
| | - Elisa Canzoneri
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
| | - Lyduine Collij
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | - Alexander Drzezga
- Department of Nuclear Medicine, University Hospital of Cologne, University of Cologne and German Center for Neurodegenerative Diseases (DZNE), Germany
| | - Gill Farrar
- Life Sciences, GE Healthcare, Amersham, Buckinghamshire, United Kingdom
| | - Valentina Garibotto
- Division of Nuclear Medicine and Molecular Imaging, Department of Medical Imaging, University Hospitals of Geneva, Geneva, Switzerland; NIMTlab, Faculty of Medicine, Geneva University, Geneva, Switzerland
| | | | - Juan-Domingo Gispert
- Barcelonaβeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Frank Jessen
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany; German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Miia Kivipelto
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden; Aging Theme, Karolinska University Hospital Stockholm, Sweden; University of Eastern Finland, Finland; School of Public Health, Imperial College, London, United Kingdom
| | - Isadora Lopes Alves
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | - José Luis Molinuevo
- Barcelonaβeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain
| | - Agneta Nordberg
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden; Aging Theme, Karolinska University Hospital Stockholm, Sweden
| | - Pierre Payoux
- Nuclear Medicine Department, University Hospital of Toulouse (CHU-Toulouse), Toulouse, France; ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Craig Ritchie
- Centre for Clinical Brain Sciences, Department of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
| | - Irina Savicheva
- Nuclear Medicine IRA, Medical Radiation Physics and Nuclear Medicine Imaging, Karolinska University Hospital, Sweden
| | - Philip Scheltens
- Alzheimer Center and Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | - Mark E Schmidt
- Experimental Medicine, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Jonathan M Schott
- Institute of Neurology, University College London, London, United Kingdom
| | - Andrew Stephens
- Piramal Imaging, Clinical Research and Development, Berlin, Germany
| | - Bart van Berckel
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | - Bruno Vellas
- Gerontopole of Toulouse, University Hospital of Toulouse (CHU-Toulouse), Toulouse, France; UMR INSERM 1027, University of Toulouse III, Toulouse, France
| | - Zuzana Walker
- Division of Psychiatry, University College London, London, United Kingdom; Essex Partnership University NHS Foundation Trust, United Kingdom
| | - Nicola Raffa
- Piramal Imaging, Market Access and HEOR, Berlin, Germany
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18
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Amyloid imaging for differential diagnosis of dementia: incremental value compared to clinical diagnosis and [ 18F]FDG PET. Eur J Nucl Med Mol Imaging 2018; 46:312-323. [PMID: 30094462 PMCID: PMC6333717 DOI: 10.1007/s00259-018-4111-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 07/10/2018] [Indexed: 11/24/2022]
Abstract
Purpose Cerebral beta-amyloid and regional glucose metabolism assessed by positron emission tomography (PET) are used as diagnostic biomarkers for Alzheimer’s disease (AD). The present study validates the incremental diagnostic value of amyloid PET in addition to clinical diagnosis and [18F]FDG PET in a real-life memory clinic population. Methods Of 138 consecutive patients with cognitive impairment who received combined [18F]FDG and [11C]PIB PET, 84 were diagnosed with major neurocognitive disorder (DSM-5) and included. Baseline clinical and [18F]FDG PET diagnoses were independently established with and without access to amyloid PET results and were dichotomized into AD or non-AD disorders. The incremental value of amyloid PET was evaluated in terms of: (1) the change in clinical and [18F]FDG PET diagnoses, (2) the change in agreement between clinical and [18F]FDG PET diagnoses, and (3) diagnostic accuracy using an interdisciplinary consensus diagnosis after an extended follow-up (2.4 ± 1.3 years after PET) as the reference. Results After disclosure of the amyloid PET results, clinical and [18F]FDG PET diagnoses changed in 23% and 18% of patients, respectively, and agreement between both ratings increased from 62% to 86% (p < 0.001). The accuracy of clinical and [18F]FDG PET diagnoses improved from 71% to 89% (p < 0.01) and from 76% to 94% (p < 0.001), respectively. The additional value of amyloid PET was rather uniform in relation to age at onset and consistency with appropriate use criteria. Conclusion Amyloid PET provides significant incremental diagnostic value beyond clinical and [18F]FDG PET diagnoses of AD. Given the high diagnostic accuracy of combined clinical and amyloid PET assessment, further studies are needed to clarify the role of an additional [18F]FDG PET scan in these patients.
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Fantoni ER, Chalkidou A, O’ Brien JT, Farrar G, Hammers A. A Systematic Review and Aggregated Analysis on the Impact of Amyloid PET Brain Imaging on the Diagnosis, Diagnostic Confidence, and Management of Patients being Evaluated for Alzheimer's Disease. J Alzheimers Dis 2018; 63:783-796. [PMID: 29689725 PMCID: PMC5929301 DOI: 10.3233/jad-171093] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Amyloid PET (aPET) imaging could improve patient outcomes in clinical practice, but the extent of impact needs quantification. OBJECTIVE To provide an aggregated quantitative analysis of the value added by aPET in cognitively impaired subjects. METHODS Systematic literature searches were performed in Embase and Medline until January 2017. 1,531 cases over 12 studies were included (1,142 cases over seven studies in the primary analysis where aPET was the key biomarker; the remaining cases included as defined groups in the secondary analysis). Data was abstracted by consensus among two observers and assessed for bias. Clinical utility was measured by diagnostic change, diagnostic confidence, and patient management before and after aPET. Three groups were further analyzed: control patients for whom feedback of aPET scan results was delayed; aPET Appropriate Use Criteria (AUC+) cases; and patients undergoing additional FDG/CSF testing. RESULTS For 1,142 cases with only aPET, 31.3% of diagnoses were revised, whereas 3.2% of diagnoses changed in the delayed aPET control group (p < 0.0001). Increased diagnostic confidence following aPET was found for 62.1% of 870 patients. Management changes with aPET were found in 72.2% of 740 cases and in 55.5% of 299 cases in the control group (p < 0.0001). The diagnostic value of aPET in AUC+ patients or when FDG/CSF were additionally available did not substantially differ from the value of aPET alone in the wider population. CONCLUSIONS Amyloid PET contributed to diagnostic revision in almost a third of cases and demonstrated value in increasing diagnostic confidence and refining management plans.
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Affiliation(s)
| | - Anastasia Chalkidou
- King’s Technology Evaluation Centre (KiTEC), London, UK
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK; King’s College London and Guy’s and St Thomas’ PET Centre, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, UK
| | | | | | - Alexander Hammers
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK; King’s College London and Guy’s and St Thomas’ PET Centre, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, UK
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Pontecorvo MJ, Siderowf A, Dubois B, Doraiswamy PM, Frisoni GB, Grundman M, Nobili F, Sadowsky CH, Salloway S, Arora AK, Chevrette A, Deberdt W, Dell'Agnello G, Flitter M, Galante N, Lowrey MJ, Lu M, McGeehan A, Devous Sr. MD, Mintun MA. Effectiveness of Florbetapir PET Imaging in Changing Patient Management. Dement Geriatr Cogn Disord 2017; 44:129-143. [PMID: 28787712 PMCID: PMC5806476 DOI: 10.1159/000478007] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2017] [Indexed: 12/24/2022] Open
Abstract
AIMS To evaluate the impact of amyloid PET imaging on diagnosis and patient management in a multicenter, randomized, controlled study. METHODS Physicians identified patients seeking a diagnosis for mild cognitive impairment or dementia, possibly due to Alzheimer disease (AD), and recorded a working diagnosis and a management plan. The patients underwent florbetapir PET scanning and were randomized to either immediate or delayed (1-year) feedback regarding amyloid status. At the 3-month visit, the physician updated the diagnosis and recorded a summary of the actual patient management since the post-scan visit. The study examined the impact of immediate versus delayed feedback on patient diagnosis/management at 3 and 12 months. RESULTS A total of 618 subjects were randomized (1:1) to immediate or delayed feedback arms, and 602 subjects completed the 3-month primary endpoint visit. A higher proportion of patients in the immediate feedback arm showed a change in diagnosis compared to the controls (32.6 vs. 6.4%; p = 0.0001). Similarly, a higher proportion of patients receiving immediate feedback had a change in management plan (68 vs. 55.5%; p < 0.002), mainly driven by changes in AD medication. Specifically, acetylcholinesterase inhibitors were prescribed to 67% of the amyloid-positive and 27% of the amyloid-negative subjects in the information group compared with 56 and 43%, respectively, in the control group (p < 0.0001). These between-group differences persisted until the 12-month visit. CONCLUSION Knowledge of the amyloid status affects the diagnosis and alters patient management.
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Affiliation(s)
- Michael J. Pontecorvo
- Avid Radiopharmaceuticals (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania, USA,*Michael J. Pontecorvo, PhD, Avid Radiopharmaceuticals (a wholly owned subsidiary of Eli Lilly and Company), 3711 Market Street, Philadelphia, PA 19104 (USA), E-Mail
| | - Andrew Siderowf
- Avid Radiopharmaceuticals (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania, USA
| | - Bruno Dubois
- Dementia Research Center (IM2A), Institut du Cerveau et de la Moelle épinière (ICM), UMR-S975, Université Pierre et Marie Curie-Paris 6, AP-HP, Hôpital de la Salpêtrière, Paris, France
| | - P. Murali Doraiswamy
- Department of Psychiatry, Duke University Health System and the Duke Institute for Brain Sciences, Durham, North Carolina, USA
| | - Giovanni B. Frisoni
- Department of Psychiatry, University Hospitals and University of Geneva, Geneva, Switzerland,Department of Internal Medicine, University Hospitals and University of Geneva, Geneva, Switzerland
| | - Michael Grundman
- Global R&D Partners, LLC, California, USA,University of California, San Diego, California, USA
| | - Flavio Nobili
- Clinical Neurology, Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy
| | | | | | - Anupa K. Arora
- Avid Radiopharmaceuticals (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania, USA
| | - Antoine Chevrette
- Avid Radiopharmaceuticals (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania, USA
| | | | | | - Matthew Flitter
- Avid Radiopharmaceuticals (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania, USA
| | - Nick Galante
- Avid Radiopharmaceuticals (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania, USA
| | - Mark J. Lowrey
- Avid Radiopharmaceuticals (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania, USA
| | - Ming Lu
- Avid Radiopharmaceuticals (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania, USA
| | - Anne McGeehan
- Avid Radiopharmaceuticals (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania, USA
| | - Michael D. Devous Sr.
- Avid Radiopharmaceuticals (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania, USA
| | - Mark A. Mintun
- Avid Radiopharmaceuticals (a wholly owned subsidiary of Eli Lilly and Company), Philadelphia, Pennsylvania, USA
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21
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Ceccaldi M, Jonveaux T, Verger A, Krolak‐Salmon P, Houzard C, Godefroy O, Shields T, Perrotin A, Gismondi R, Bullich S, Jovalekic A, Raffa N, Pasquier F, Semah F, Dubois B, Habert M, Wallon D, Chastan M, Payoux P, Ceccaldi M, Guedj E, Ceccaldi M, Felician O, Didic M, Gueriot C, Koric L, Kletchkova‐Gantchev R, Guedj E, Godefroy O, Andriuta D, Devendeville A, Dupuis D, Binot I, Barbay M, Meyer M, Moullard V, Magnin E, Chamard L, Haffen S, Morel O, Drouet C, Boulahdour H, Goas P, Querellou‐Lefranc S, Sayette V, Cogez J, Branger P, Agostini D, Manrique A, Rouaud O, Bejot Y, Jacquin‐Piques A, Dygai‐Cochet I, Berriolo‐Riedinger A, Moreaud O, Sauvee M, Crépin CG, Pasquier F, Bombois S, Lebouvier T, Mackowiak‐Cordoliani M, Deramecourt V, Rollin‐Sillaire A, Cassagnaud‐Thuillet P, Chen Y, Semah F, Petyt G, Krolak‐Salmon P, Federico D, Danaila KL, Guilhermet Y, Magnier C, Makaroff Z, Rouch I, Xie J, Roubaud C, Coste M, David K, Sarciron A, Waissi AS, Scheiber C, Houzard C, Gabelle‐Deloustal A, Bennys K, Marelli C, Touati L, Mariano‐Goulart D, Verbizier‐Lonjon D, Jonveaux T, Benetos A, Kearney‐Schwartz A, Perret‐Guillaume C, Verger A, Vercelletto M, Boutoleau‐Bretonniere C, Pouclet‐Courtemanche H, Wagemann N, Pallardy A, Hugon J, Paquet C, Dumurgier J, Millet P, Queneau M, Dubois B, Epelbaum S, Levy M, Habert M, Novella J, Jaidi Y, Papathanassiou D, Morland D, Belliard S, Salmon A, Lejeune F, Hannequin D, Wallon D, Martinaud O, Zarea A, Chastan M, Pariente J, Thalamas C, Galitzky‐Gerber M, Tricoire Ricard A, Calvas F, Rigal E, Payoux P, Hitzel A, Delrieu J, Ousset P, Lala F, Sastre‐Hengan N, Stephens A, Guedj E. Added value of
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F‐florbetaben amyloid PET in the diagnostic workup of most complex patients with dementia in France: A naturalistic study. Alzheimers Dement 2017; 14:293-305. [DOI: 10.1016/j.jalz.2017.09.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 08/29/2017] [Accepted: 09/06/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Mathieu Ceccaldi
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Thérèse Jonveaux
- Geriatric Department CHRU de Nancy–Hôpital Brabois Vandoeuvre‐les‐Nancy France
| | - Antoine Verger
- INSERM U947 Unité d'Imagerie Adaptative Diagnostique et Interventionnelle Nancy France
| | - Pierre Krolak‐Salmon
- Clinical and Research Memory Center of Lyon Hospices civils de Lyon, Université Claude Bernard Lyon 1 Inserm 1028 Lyon France
| | | | - Olivier Godefroy
- Neurology Department CHU Amiens Picardie–Hôpital Sud Amiens France
| | - Trevor Shields
- Nuclear Medicine Department CHU Amiens Picardie–Hôpital Sud Amiens France
| | - Audrey Perrotin
- Piramal Imaging Clinical Research and Development Berlin Germany
| | | | - Santiago Bullich
- AP‐HP–Hôpital Pitié Salpétrière Memory and Alzheimer Disease Institute IM2A Paris France
| | - Aleksandar Jovalekic
- Laboratoire d'Imagerie Biomédicale Sorbonne Universités, UPMC Univ Paris 06, Inserm U 1146, CNRS UMR 7371 Paris France
| | - Nicola Raffa
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Florence Pasquier
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Franck Semah
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Bruno Dubois
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Marie‐Odile Habert
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - David Wallon
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Mathieu Chastan
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Pierre Payoux
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Mathieu Ceccaldi
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Eric Guedj
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Mathieu Ceccaldi
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Olivier Felician
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Mira Didic
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Claude Gueriot
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Lejla Koric
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Radka Kletchkova‐Gantchev
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Eric Guedj
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Olivier Godefroy
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Daniela Andriuta
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Agnès Devendeville
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Diane Dupuis
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Ingrid Binot
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Mélanie Barbay
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Marc‐Etienne Meyer
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Véronique Moullard
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Eloi Magnin
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Ludivine Chamard
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Sophie Haffen
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Olivier Morel
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Clément Drouet
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Hatem Boulahdour
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Philippe Goas
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Solène Querellou‐Lefranc
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Vincent Sayette
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Julien Cogez
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Pierre Branger
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Denis Agostini
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Alain Manrique
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Olivier Rouaud
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Yannick Bejot
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Agnès Jacquin‐Piques
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Inna Dygai‐Cochet
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Alina Berriolo‐Riedinger
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Olivier Moreaud
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Mathilde Sauvee
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Céline Gallazzani Crépin
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Florence Pasquier
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Stéphanie Bombois
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Thibaud Lebouvier
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Marie‐Anne Mackowiak‐Cordoliani
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Vincent Deramecourt
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Adeline Rollin‐Sillaire
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Pascaline Cassagnaud‐Thuillet
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Yaohua Chen
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Franck Semah
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Grégory Petyt
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Pierre Krolak‐Salmon
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Denis Federico
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Keren Liora Danaila
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Yves Guilhermet
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Christophe Magnier
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Zaza Makaroff
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Isabelle Rouch
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Jing Xie
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Caroline Roubaud
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Marie‐Hélène Coste
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Kenny David
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Alain Sarciron
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Aziza Sediq Waissi
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Christian Scheiber
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Claire Houzard
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Audrey Gabelle‐Deloustal
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Karim Bennys
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Cecilia Marelli
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Lynda Touati
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Denis Mariano‐Goulart
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Delphine Verbizier‐Lonjon
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Thérèse Jonveaux
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Athanase Benetos
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Anna Kearney‐Schwartz
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Christine Perret‐Guillaume
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Antoine Verger
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Martine Vercelletto
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Claire Boutoleau‐Bretonniere
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Hélène Pouclet‐Courtemanche
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Nathalie Wagemann
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Amandine Pallardy
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Jacques Hugon
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Claire Paquet
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Julien Dumurgier
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Pascal Millet
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Mathieu Queneau
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Bruno Dubois
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Stéphane Epelbaum
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Marcel Levy
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | | | - Jean‐Luc Novella
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Yacine Jaidi
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Dimitri Papathanassiou
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | | | - Serge Belliard
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Anne Salmon
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Florence Lejeune
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Didier Hannequin
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - David Wallon
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Olivier Martinaud
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Aline Zarea
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Mathieu Chastan
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | | | - Claire Thalamas
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | | | | | - Fabienne Calvas
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Emilie Rigal
- ToNIC, Toulouse NeuroImaging Center Université de Toulouse, Inserm, UPS Toulouse France
| | - Pierre Payoux
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Anne Hitzel
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Julien Delrieu
- Neurology Department CHU de Rouen–Hôpital Charles Nicolle Rouen France
| | - Pierre‐Jean Ousset
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Françoise Lala
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Nathalie Sastre‐Hengan
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Andrew Stephens
- AP‐HM–Hôpital de la Timone, Neurology and Neuropsychology Department Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes Marseille France
| | - Eric Guedj
- AP‐HM–Hôpital de la Timone, Nuclear Medicine Department Aix‐Marseille University, CERIMED, CNRS, INT, Institut de Neurosciences de la Timone Marseille France
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Additive value of amyloid-PET in routine cases of clinical dementia work-up after FDG-PET. Eur J Nucl Med Mol Imaging 2017; 44:2239-2248. [PMID: 28932894 DOI: 10.1007/s00259-017-3832-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 09/06/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE In recent years, several [18F]-labeled amyloid-PET tracers have been developed and have obtained clinical approval. Despite their widespread scientific use, studies in routine clinical settings are limited. We therefore investigated the impact of [18F]-florbetaben (FBB)-PET on the diagnostic management of patients with suspected dementia that was still unclarified after [18F]-fluordeoxyglucose (FDG)-PET. METHODS All subjects were referred in-house with a suspected dementia syndrome due to neurodegenerative disease. After undergoing an FDG-PET exam, the cases were discussed by the interdisciplinary dementia board, where the most likely diagnosis as well as potential differential diagnoses were documented. Because of persistent diagnostic uncertainty, the patients received an additional FBB-PET exam. Results were interpreted visually and classified as amyloid-positive or amyloid-negative, and we then compared the individual clinical diagnoses before and after additional FBB-PET. RESULTS A total of 107 patients (mean age 69.4 ± 9.7y) were included in the study. The FBB-PET was rated as amyloid-positive in 65/107. In 83% of the formerly unclear cases, a final diagnosis was reached through FBB-PET, and the most likely prior diagnosis was changed in 28% of cases. The highest impact was observed for distinguishing Alzheimer's dementia (AD) from fronto-temporal dementia (FTLD), where FBB-PET altered the most likely diagnosis in 41% of cases. CONCLUSIONS FBB-PET has a high additive value in establishing a final diagnosis in suspected dementia cases when prior investigations such as FDG-PET are inconclusive. The differentiation between AD and FTLD was particularly facilitated by amyloid-PET, predicting a considerable impact on patient management, especially in the light of upcoming disease-modifying therapies.
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23
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Barthel H, Sabri O. Clinical Use and Utility of Amyloid Imaging. J Nucl Med 2017; 58:1711-1717. [PMID: 28818990 DOI: 10.2967/jnumed.116.185017] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 08/10/2017] [Indexed: 11/16/2022] Open
Abstract
Currently, 3 amyloid PET tracers are approved and commercially available for clinical use. They allow for the accurate in vivo detection of amyloid plaques, one hallmark of Alzheimer disease. Here, we review the current knowledge on the clinical use and utility of amyloid imaging. Appropriate use criteria for the clinical application of amyloid imaging are established, and most currently available data point to their validity. Visual amyloid image analysis is highly standardized. Disclosure of amyloid imaging results is desired by many cognitively impaired subjects and seems to be safe once appropriate education is delivered to the disclosing clinicians. Regarding clinical utility, increasing evidence points to a change in diagnosis via amyloid imaging in about 30% of cases, to an increase in diagnostic confidence in about 60% of cases, to a change in patient management in about 60% of cases, and specifically to a change in medication in about 40% of cases. Also, amyloid imaging results seem to have a relevant impact on caregivers. Further, initial simulation studies point to a potential positive effect on patient outcome and to cost effectiveness of amyloid imaging. These features, however, will require confirmation in prospective clinical trials. More work is also required to determine the clinical utility of amyloid imaging specifically in subjects with mild cognitive impairment and in comparison with or in conjunction with other Alzheimer disease biomarkers. In summary, the clinical use of amyloid imaging is being studied, and the currently available data point to a relevant clinical utility of this imaging technique. Ongoing research will determine whether this accurate and noninvasive approach to amyloid plaque load detection will translate into a benefit to cognitively impaired subjects.
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Affiliation(s)
- Henryk Barthel
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
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24
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Grill JD, Apostolova LG, Bullain S, Burns JM, Cox CG, Dick M, Hartley D, Kawas C, Kremen S, Lingler J, Lopez OL, Mapstone M, Pierce A, Rabinovici G, Roberts JS, Sajjadi SA, Teng E, Karlawish J. Communicating mild cognitive impairment diagnoses with and without amyloid imaging. ALZHEIMERS RESEARCH & THERAPY 2017; 9:35. [PMID: 28472970 PMCID: PMC5418690 DOI: 10.1186/s13195-017-0261-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 04/06/2017] [Indexed: 11/10/2022]
Abstract
Background Mild cognitive impairment (MCI) has an uncertain etiology and prognosis and may be challenging for clinicians to discuss with patients and families. Amyloid imaging may aid specialists in determining MCI etiology and prognosis, but creates novel challenges related to disease labeling. Methods We convened a workgroup to formulate recommendations for clinicians providing care to MCI patients. Results Clinicians should use the MCI diagnosis to validate patient and family concerns and educate them that the patient’s cognitive impairment is not normal for his or her age and education level. The MCI diagnosis should not be used to avoid delivering a diagnosis of dementia. For patients who meet Appropriate Use Criteria after standard-of-care clinical workup, amyloid imaging may position specialists to offer more information about etiology and prognosis. Clinicians must set appropriate expectations, including ensuring that patients and families understand the limitations of amyloid imaging. Communication of negative results should include that patients remain at elevated risk for dementia and that negative scans do not indicate a specific diagnosis or signify brain health. Positive amyloid imaging results should elicit further monitoring and conversations about appropriate advance planning. Clinicians should offer written summaries, including referral to appropriate social services. Conclusions In patients with MCI, there is a need to devote considerable time and attention to patient education and shared decision-making. Amyloid imaging may be a tool to aid clinicians. Careful management of patient expectations and communication of scan results will be critical to the appropriate use of amyloid imaging information.
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Affiliation(s)
- Joshua D Grill
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA. .,Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA. .,Institute for Memory Impairments and Neurological Disorders, University of California, 3204 Biological Sciences III, Irvine, CA, 92697, USA.
| | - Liana G Apostolova
- Alzheimer's Disease Center, Department of Neurology, Radiology, Medical and Molecular Genetics, University of Indiana, Indianapolis, IN, USA.,Mary S. Easton Center for Alzheimer's Disease Research, Department of Neurology, David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | - Szofia Bullain
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA.,Department of Neurology, University of California, Irvine, CA, USA
| | | | - Chelsea G Cox
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
| | - Malcolm Dick
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
| | | | - Claudia Kawas
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA.,Department of Neurology, University of California, Irvine, CA, USA
| | - Sarah Kremen
- Mary S. Easton Center for Alzheimer's Disease Research, Department of Neurology, David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | | | | | - Mark Mapstone
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA.,Department of Neurology, University of California, Irvine, CA, USA
| | - Aimee Pierce
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA.,Department of Neurology, University of California, Irvine, CA, USA
| | | | - J Scott Roberts
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Seyed Ahmad Sajjadi
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA.,Department of Neurology, University of California, Irvine, CA, USA
| | - Edmond Teng
- Mary S. Easton Center for Alzheimer's Disease Research, Department of Neurology, David Geffen School of Medicine at University of California, Los Angeles, CA, USA.,Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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Validation of an electronic image reader training programme for interpretation of [18F]flutemetamol β-amyloid PET brain images. Nucl Med Commun 2017; 38:234-241. [PMID: 27984539 PMCID: PMC5318150 DOI: 10.1097/mnm.0000000000000633] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objectives An electronic training programme (ETP) was developed for interpretation of images during routine clinical use of the PET amyloid imaging agent [18F]flutemetamol injection (VIZAMYL). This study was carried out to validate the ETP. Materials and methods Five nuclear medicine technologists (NMTs) and five readers previously inexperienced in amyloid image interpretation were required to self-train using the ETP and pass a test to participate. A total of 305 [18F]flutemetamol PET images were then tested as the validation set, following preassessment and reorientation (where required) by one of five NMTs. Next, a new set of readers blinded to clinical information independently assessed all 305 images. Images had been acquired in previous studies from patients representing the full spectrum of cognitive capacity. When available, a standard of truth determined by histopathology or clinical history was used to derive sensitivity and specificity for image interpretation from this validation set. Randomly selected images (n=29) were read in duplicate to measure intrareader reproducibility. Images were read first without, and subsequently with anatomic images, if available. Results All NMTs and all readers scored 100% on the qualifying test. The interpretation of 135 cases without anatomic image support resulted in sensitivity ranging from 84% to 94% (majority 94%, median 92%) and specificity ranging from 77% to 96% (majority 92%, median 81%). Inter-reader agreement was very high, with most κ scores more than 0.8. Intrareader reproducibility ranged from 93 to 100%. Conclusion The self-guided ETP effectively trained new amyloid PET image readers to accurately and reproducibly interpret [18F]flutemetamol PET images.
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Diagnostic role of 11C-Pittsburgh compound B retention patterns and glucose metabolism by fluorine-18-fluorodeoxyglucose PET/CT in amnestic and nonamnestic mild cognitive impairment patients. Nucl Med Commun 2017; 37:1189-96. [PMID: 27341411 DOI: 10.1097/mnm.0000000000000569] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Amyloid imaging clinically is usually reported as positive or negative, and the role of amyloid topography has not been studied before. To evaluate in a clinical setting the regional distribution patterns of C-Pittsburgh compound B (C-PIB) and the fluorine-18-fluorodeoxyglucose (F-FDG) uptake in patients with mild cognitive impairment (MCI), we designed this study. METHODS We studied 81 consecutive MCI patients, 64 amnestic (A-MCI) and 17 nonamnestic (NA-MCI) by C-PIB and F-FDG PET/computed tomography, by visual analysis. PIB retention was classified according to the regional distribution into the following patterns: A (frontal, lateral temporal, basal ganglia and anterior cingulate) and B (global retention). F-FDG images were considered positive only if temporoparietal hypometabolism consistent with Alzheimer's disease was observed. RESULTS In 42 of the 64 A-MCI, C-PIB was positive. Twelve of the 42 positive A-MCI showed an A-pattern, all F-FDG negative, and 30 a B-pattern, 10 F-FDG positive and 20 F-FDG negative. Of the 17 NA-MCI, C-PIB was positive in three and F-FDG was positive in one. The different proportion of C-PIB positivity in A-MCI and NA-MCI was highly significant (P<0.001). CONCLUSION Two different C-PIB patterns were observed in MCI patients and for the A-pattern, glucose hypometabolism consistent with Alzheimer's disease is highly unlikely. These findings may contribute towards a better selection of patients for future potential treatments and also to optimize the use of F-FDG-PET/CT.
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27
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Zwan MD, Bouwman FH, Konijnenberg E, van der Flier WM, Lammertsma AA, Verhey FRJ, Aalten P, van Berckel BNM, Scheltens P. Diagnostic impact of [ 18F]flutemetamol PET in early-onset dementia. ALZHEIMERS RESEARCH & THERAPY 2017; 9:2. [PMID: 28093088 PMCID: PMC5240413 DOI: 10.1186/s13195-016-0228-4] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 12/08/2016] [Indexed: 12/20/2022]
Abstract
Background Early-onset dementia patients often present with atypical clinical symptoms, hampering an accurate clinical diagnosis. The purpose of the present study was to assess the diagnostic impact of the amyloid-positron emission tomography (PET) imaging agent [18F]flutemetamol in early-onset dementia patients, in terms of change in (confidence in) diagnosis and patient management plan. Methods This prospective bi-center study included 211 patients suspected of early-onset dementia who visited a tertiary memory clinic. Patients were eligible with Mini Mental State Examination ≥ 18 and age at diagnosis ≤ 70 years and in whom the diagnostic confidence was <90% after routine diagnostic work-up. All patients underwent [18F]flutemetamol PET, which was interpreted as amyloid-negative or amyloid-positive based on visual rating. Before and after disclosing the PET results, we assessed the diagnostic confidence (using a visual analog scale of 0–100%) and clinical diagnosis. The impact of [18F]flutemetamol PET on the patient management plan was also evaluated. Results [18F]flutemetamol PET scans were positive in 133 out of 211 (63%) patients, of whom 110 out of 144 (76%) patients had a pre-PET Alzheimer’s disease (AD) diagnosis and 23 out of 67 (34%) patients had a non-AD diagnosis. After disclosure of PET results, 41/211 (19%) diagnoses changed. Overall, diagnostic confidence increased from 69 ± 12% to 88 ± 15% after disclosing PET results (P < 0.001; in 87% of patients). In 79 (37%) patients, PET results led to a change in patient management and predominantly the initiation of AD medication when PET showed evidence for amyloid pathology. Conclusions [18F]flutemetamol PET changed clinical diagnosis, increased overall diagnostic confidence, and altered the patient management plan. Our results suggest that amyloid PET may have added value over the standardized diagnostic work-up in early-onset dementia patients with uncertain clinical diagnosis. This study provides evidence for the recommendations put forward in the appropriate use criteria for amyloid PET in clinical practice. Trial registration Nederlands Trial Register NTR3743. Registered 7 December 2012.
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Affiliation(s)
- Marissa D Zwan
- Alzheimer Center & Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands. .,Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands.
| | - Femke H Bouwman
- Alzheimer Center & Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Elles Konijnenberg
- Alzheimer Center & Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center & Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.,Department of Epidemiology & Biostatistics, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Adriaan A Lammertsma
- Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Frans R J Verhey
- School for Mental Health and Neuroscience, Alzheimer Centre Limburg, European Graduate School of Neuroscience EURON, Maastricht University, Maastricht, The Netherlands
| | - Pauline Aalten
- School for Mental Health and Neuroscience, Alzheimer Centre Limburg, European Graduate School of Neuroscience EURON, Maastricht University, Maastricht, The Netherlands
| | - Bart N M van Berckel
- Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Philip Scheltens
- Alzheimer Center & Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
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Weston PS, Paterson RW, Dickson J, Barnes A, Bomanji JB, Kayani I, Lunn MP, Mummery CJ, Warren JD, Rossor MN, Fox NC, Zetterberg H, Schott JM. Diagnosing Dementia in the Clinical Setting: Can Amyloid PET Provide Additional Value Over Cerebrospinal Fluid? J Alzheimers Dis 2016; 54:1297-1302. [PMID: 27567830 PMCID: PMC5181662 DOI: 10.3233/jad-160302] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2016] [Indexed: 11/28/2022]
Abstract
Cerebrospinal fluid (CSF) measures of amyloid and tau are the first-line Alzheimer's disease biomarkers in many clinical centers. We assessed if and when the addition of amyloid PET following CSF measurements provides added diagnostic value. Twenty patients from a cognitive clinic, who had undergone detailed assessment including CSF measures, went on to have amyloid PET. The treating neurologist's working diagnosis, and degree of diagnostic certainty, was assessed both before and after the PET. Amyloid PET changed the diagnosis in 7/20 cases. Amyloid PET can provide added diagnostic value, particularly in young-onset, atypical dementias, where CSF results are borderline and diagnostic uncertainty remains.
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Affiliation(s)
- Philip S.J. Weston
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
| | - Ross W. Paterson
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
| | - John Dickson
- Institute of Nuclear Medicine, University College London Hospitals, London, UK
| | - Anna Barnes
- Institute of Nuclear Medicine, University College London Hospitals, London, UK
| | - Jamshed B. Bomanji
- Institute of Nuclear Medicine, University College London Hospitals, London, UK
| | - Irfan Kayani
- Institute of Nuclear Medicine, University College London Hospitals, London, UK
| | - Michael P. Lunn
- Department of Molecular Neuroscience, UCL Institute of Neurology, University College London, UK
| | - Catherine J. Mummery
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
| | - Jason D. Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
| | - Martin N. Rossor
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
| | - Nick C. Fox
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
| | - Henrik Zetterberg
- Department of Molecular Neuroscience, UCL Institute of Neurology, University College London, UK
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Jonathan M. Schott
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
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Grundman M, Johnson KA, Lu M, Siderowf A, Dell’Agnello G, Arora AK, Skovronsky DM, Mintun MA, Pontecorvo MJ. Effect of Amyloid Imaging on the Diagnosis and Management of Patients with Cognitive Decline: Impact of Appropriate Use Criteria. Dement Geriatr Cogn Disord 2016; 41:80-92. [PMID: 26745445 PMCID: PMC6625826 DOI: 10.1159/000441139] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Published appropriate use criteria (AUC) describe patients for whom amyloid positron emission tomography (PET) might be most useful. This study compared the impact of amyloid PET on diagnosis and management in subjects likely to either meet or not meet AUC. METHODS Physicians provided a provisional diagnosis and management plan for patients presenting with cognitive decline before and after amyloid PET imaging with florbetapir F 18. Participants were classified as AUC-like or not, based on the prescan diagnosis and demographic features. RESULTS In all, 125 of 229 participants (55%) were classified as AUC-like. Sixty-two percent of the AUC-like subjects had a change in diagnosis after scanning compared with 45% of the non-AUC subjects (p = 0.011). Both groups demonstrated high rates of change in their management plans after scanning (88.0% for AUC-like cases, 85.6% for non-AUC cases). CONCLUSIONS The impact of amyloid imaging on diagnosis and planned management was maintained and, if anything, amplified in AUC-like patients.
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Affiliation(s)
- Michael Grundman
- Global R&D Partners, LLC, and University of California, San Diego, Calif.,Department of Neurosciences, University of California, San Diego, Calif
| | - Keith A. Johnson
- Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Ming Lu
- Avid Radiopharmaceuticals, Inc., Philadelphia, Pa., USA
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Boccardi M, Altomare D, Ferrari C, Festari C, Antelmi L, Pievani M, Tarallo A, Muscio C, Guerra UP, Paghera B, Padovani A, Frisoni GB. Do Beliefs about the Pathogenetic Role of Amyloid Affect the Interpretation of Amyloid PET in the Clinic? NEURODEGENER DIS 2015; 16:111-7. [DOI: 10.1159/000439255] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 08/07/2015] [Indexed: 11/19/2022] Open
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Zwan MD, Rinne JO, Hasselbalch SG, Nordberg A, Lleó A, Herukka SK, Soininen H, Law I, Bahl JMC, Carter SF, Fortea J, Blesa R, Teunissen CE, Bouwman FH, van Berckel BNM, Visser PJ. Use of amyloid-PET to determine cutpoints for CSF markers: A multicenter study. Neurology 2015; 86:50-8. [PMID: 26468410 DOI: 10.1212/wnl.0000000000002081] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 08/28/2015] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To define CSF β-amyloid 1-42 (Aβ42) cutpoints to detect cortical amyloid deposition as assessed by 11C-Pittsburgh compound B ([11C]PiB)-PET and to compare these calculated cutpoints with cutpoints currently used in clinical practice. METHODS We included 433 participants (57 controls, 99 with mild cognitive impairment, 195 with Alzheimer disease [AD] dementia, and 82 with non-AD dementia) from 5 European centers. We calculated for each center and for the pooled cohort CSF Aβ42 and Aβ42/tau ratio cutpoints for cortical amyloid deposition based on visual interpretation of [11C]PiB-PET images. RESULTS Amyloid-PET-based calculated CSF Aβ42 cutpoints ranged from 521 to 616 pg/mL, whereas existing clinical-based cutpoints ranged from 400 to 550 pg/mL. Using the calculated cutpoint from the pooled sample (557 pg/mL), concordance between CSF Aβ42 and amyloid-PET was 84%. Similar concordance was found when using a dichotomized Aβ42/tau ratio. Exploratory analysis showed that participants with a positive amyloid-PET and normal CSF Aβ42 levels had higher CSF tau and phosphorylated tau levels and more often had mild cognitive impairment or AD dementia compared with participants who had negative amyloid-PET and abnormal CSF Aβ42 levels. CONCLUSIONS Amyloid-PET-based CSF Aβ42 cutpoints were higher and tended to reduce intercenter variability compared with clinical-based cutpoints. Discordant participants with normal CSF Aβ42 and a positive amyloid-PET may be more likely to have AD-related amyloid pathology than participants with abnormal CSF Aβ42 and a negative amyloid-PET. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that an amyloid-PET-based CSF Aβ42 cutpoint identifies individuals with amyloid deposition with a sensitivity of 87% and specificity of 80%.
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Affiliation(s)
- Marissa D Zwan
- From the Alzheimer Center & Department of Neurology (M.D.Z., F.H.B., P.J.V.) and Department of Clinical Chemistry (C.E.T.), Neuroscience Campus Amsterdam, VU University Medical Center, the Netherlands; Turku PET Centre and Department of Neurology (J.O.R.), University of Turku and Turku University Hospital, Finland; Danish Dementia Research Centre (S.G.H.), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of NVS (A.N., S.F.C.), Centre for Alzheimer Research, Translational Alzheimer Neurobiology, Karolinska Institutet, Stockholm; Department of Geriatric Medicine (A.N.), Karolinska University Hospital, Stockholm, Sweden; Memory Unit (A.L., J.F., R.B.), Department of Neurology, Hospital de Sant Pau, Barcelona; CIBERNED (A.L., J.F., R.B.), Center for Network Biomedical Research into Neurodegenerative Diseases, Instituto de Salud Carlos III, Madrid, Spain; Institute of Clinical Medicine-Neurology (S.-K.H., H.S., J.M.C.B.), University of Eastern Finland, Kuopio; Department of Clinical Physiology (I.L.), Nuclear Medicine and PET, Rigshospitalet, Copenhagen; Department of Autoimmunology and Biomarkers (J.M.C.B.), Statens Serum Institut, Copenhagen, Denmark; Wolfson Molecular Imaging Centre (S.F.C.), Institute of Brain Behaviour and Mental Health, University of Manchester, UK; Department of Radiology & Nuclear Medicine (B.N.M.v.B.), VU University Medical Center, Amsterdam; and Department of Psychiatry and Neuropsychology (P.J.V.), Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands.
| | - Juha O Rinne
- From the Alzheimer Center & Department of Neurology (M.D.Z., F.H.B., P.J.V.) and Department of Clinical Chemistry (C.E.T.), Neuroscience Campus Amsterdam, VU University Medical Center, the Netherlands; Turku PET Centre and Department of Neurology (J.O.R.), University of Turku and Turku University Hospital, Finland; Danish Dementia Research Centre (S.G.H.), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of NVS (A.N., S.F.C.), Centre for Alzheimer Research, Translational Alzheimer Neurobiology, Karolinska Institutet, Stockholm; Department of Geriatric Medicine (A.N.), Karolinska University Hospital, Stockholm, Sweden; Memory Unit (A.L., J.F., R.B.), Department of Neurology, Hospital de Sant Pau, Barcelona; CIBERNED (A.L., J.F., R.B.), Center for Network Biomedical Research into Neurodegenerative Diseases, Instituto de Salud Carlos III, Madrid, Spain; Institute of Clinical Medicine-Neurology (S.-K.H., H.S., J.M.C.B.), University of Eastern Finland, Kuopio; Department of Clinical Physiology (I.L.), Nuclear Medicine and PET, Rigshospitalet, Copenhagen; Department of Autoimmunology and Biomarkers (J.M.C.B.), Statens Serum Institut, Copenhagen, Denmark; Wolfson Molecular Imaging Centre (S.F.C.), Institute of Brain Behaviour and Mental Health, University of Manchester, UK; Department of Radiology & Nuclear Medicine (B.N.M.v.B.), VU University Medical Center, Amsterdam; and Department of Psychiatry and Neuropsychology (P.J.V.), Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands
| | - Steen G Hasselbalch
- From the Alzheimer Center & Department of Neurology (M.D.Z., F.H.B., P.J.V.) and Department of Clinical Chemistry (C.E.T.), Neuroscience Campus Amsterdam, VU University Medical Center, the Netherlands; Turku PET Centre and Department of Neurology (J.O.R.), University of Turku and Turku University Hospital, Finland; Danish Dementia Research Centre (S.G.H.), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of NVS (A.N., S.F.C.), Centre for Alzheimer Research, Translational Alzheimer Neurobiology, Karolinska Institutet, Stockholm; Department of Geriatric Medicine (A.N.), Karolinska University Hospital, Stockholm, Sweden; Memory Unit (A.L., J.F., R.B.), Department of Neurology, Hospital de Sant Pau, Barcelona; CIBERNED (A.L., J.F., R.B.), Center for Network Biomedical Research into Neurodegenerative Diseases, Instituto de Salud Carlos III, Madrid, Spain; Institute of Clinical Medicine-Neurology (S.-K.H., H.S., J.M.C.B.), University of Eastern Finland, Kuopio; Department of Clinical Physiology (I.L.), Nuclear Medicine and PET, Rigshospitalet, Copenhagen; Department of Autoimmunology and Biomarkers (J.M.C.B.), Statens Serum Institut, Copenhagen, Denmark; Wolfson Molecular Imaging Centre (S.F.C.), Institute of Brain Behaviour and Mental Health, University of Manchester, UK; Department of Radiology & Nuclear Medicine (B.N.M.v.B.), VU University Medical Center, Amsterdam; and Department of Psychiatry and Neuropsychology (P.J.V.), Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands
| | - Agneta Nordberg
- From the Alzheimer Center & Department of Neurology (M.D.Z., F.H.B., P.J.V.) and Department of Clinical Chemistry (C.E.T.), Neuroscience Campus Amsterdam, VU University Medical Center, the Netherlands; Turku PET Centre and Department of Neurology (J.O.R.), University of Turku and Turku University Hospital, Finland; Danish Dementia Research Centre (S.G.H.), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of NVS (A.N., S.F.C.), Centre for Alzheimer Research, Translational Alzheimer Neurobiology, Karolinska Institutet, Stockholm; Department of Geriatric Medicine (A.N.), Karolinska University Hospital, Stockholm, Sweden; Memory Unit (A.L., J.F., R.B.), Department of Neurology, Hospital de Sant Pau, Barcelona; CIBERNED (A.L., J.F., R.B.), Center for Network Biomedical Research into Neurodegenerative Diseases, Instituto de Salud Carlos III, Madrid, Spain; Institute of Clinical Medicine-Neurology (S.-K.H., H.S., J.M.C.B.), University of Eastern Finland, Kuopio; Department of Clinical Physiology (I.L.), Nuclear Medicine and PET, Rigshospitalet, Copenhagen; Department of Autoimmunology and Biomarkers (J.M.C.B.), Statens Serum Institut, Copenhagen, Denmark; Wolfson Molecular Imaging Centre (S.F.C.), Institute of Brain Behaviour and Mental Health, University of Manchester, UK; Department of Radiology & Nuclear Medicine (B.N.M.v.B.), VU University Medical Center, Amsterdam; and Department of Psychiatry and Neuropsychology (P.J.V.), Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands
| | - Alberto Lleó
- From the Alzheimer Center & Department of Neurology (M.D.Z., F.H.B., P.J.V.) and Department of Clinical Chemistry (C.E.T.), Neuroscience Campus Amsterdam, VU University Medical Center, the Netherlands; Turku PET Centre and Department of Neurology (J.O.R.), University of Turku and Turku University Hospital, Finland; Danish Dementia Research Centre (S.G.H.), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of NVS (A.N., S.F.C.), Centre for Alzheimer Research, Translational Alzheimer Neurobiology, Karolinska Institutet, Stockholm; Department of Geriatric Medicine (A.N.), Karolinska University Hospital, Stockholm, Sweden; Memory Unit (A.L., J.F., R.B.), Department of Neurology, Hospital de Sant Pau, Barcelona; CIBERNED (A.L., J.F., R.B.), Center for Network Biomedical Research into Neurodegenerative Diseases, Instituto de Salud Carlos III, Madrid, Spain; Institute of Clinical Medicine-Neurology (S.-K.H., H.S., J.M.C.B.), University of Eastern Finland, Kuopio; Department of Clinical Physiology (I.L.), Nuclear Medicine and PET, Rigshospitalet, Copenhagen; Department of Autoimmunology and Biomarkers (J.M.C.B.), Statens Serum Institut, Copenhagen, Denmark; Wolfson Molecular Imaging Centre (S.F.C.), Institute of Brain Behaviour and Mental Health, University of Manchester, UK; Department of Radiology & Nuclear Medicine (B.N.M.v.B.), VU University Medical Center, Amsterdam; and Department of Psychiatry and Neuropsychology (P.J.V.), Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands
| | - Sanna-Kaisa Herukka
- From the Alzheimer Center & Department of Neurology (M.D.Z., F.H.B., P.J.V.) and Department of Clinical Chemistry (C.E.T.), Neuroscience Campus Amsterdam, VU University Medical Center, the Netherlands; Turku PET Centre and Department of Neurology (J.O.R.), University of Turku and Turku University Hospital, Finland; Danish Dementia Research Centre (S.G.H.), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of NVS (A.N., S.F.C.), Centre for Alzheimer Research, Translational Alzheimer Neurobiology, Karolinska Institutet, Stockholm; Department of Geriatric Medicine (A.N.), Karolinska University Hospital, Stockholm, Sweden; Memory Unit (A.L., J.F., R.B.), Department of Neurology, Hospital de Sant Pau, Barcelona; CIBERNED (A.L., J.F., R.B.), Center for Network Biomedical Research into Neurodegenerative Diseases, Instituto de Salud Carlos III, Madrid, Spain; Institute of Clinical Medicine-Neurology (S.-K.H., H.S., J.M.C.B.), University of Eastern Finland, Kuopio; Department of Clinical Physiology (I.L.), Nuclear Medicine and PET, Rigshospitalet, Copenhagen; Department of Autoimmunology and Biomarkers (J.M.C.B.), Statens Serum Institut, Copenhagen, Denmark; Wolfson Molecular Imaging Centre (S.F.C.), Institute of Brain Behaviour and Mental Health, University of Manchester, UK; Department of Radiology & Nuclear Medicine (B.N.M.v.B.), VU University Medical Center, Amsterdam; and Department of Psychiatry and Neuropsychology (P.J.V.), Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands
| | - Hilkka Soininen
- From the Alzheimer Center & Department of Neurology (M.D.Z., F.H.B., P.J.V.) and Department of Clinical Chemistry (C.E.T.), Neuroscience Campus Amsterdam, VU University Medical Center, the Netherlands; Turku PET Centre and Department of Neurology (J.O.R.), University of Turku and Turku University Hospital, Finland; Danish Dementia Research Centre (S.G.H.), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of NVS (A.N., S.F.C.), Centre for Alzheimer Research, Translational Alzheimer Neurobiology, Karolinska Institutet, Stockholm; Department of Geriatric Medicine (A.N.), Karolinska University Hospital, Stockholm, Sweden; Memory Unit (A.L., J.F., R.B.), Department of Neurology, Hospital de Sant Pau, Barcelona; CIBERNED (A.L., J.F., R.B.), Center for Network Biomedical Research into Neurodegenerative Diseases, Instituto de Salud Carlos III, Madrid, Spain; Institute of Clinical Medicine-Neurology (S.-K.H., H.S., J.M.C.B.), University of Eastern Finland, Kuopio; Department of Clinical Physiology (I.L.), Nuclear Medicine and PET, Rigshospitalet, Copenhagen; Department of Autoimmunology and Biomarkers (J.M.C.B.), Statens Serum Institut, Copenhagen, Denmark; Wolfson Molecular Imaging Centre (S.F.C.), Institute of Brain Behaviour and Mental Health, University of Manchester, UK; Department of Radiology & Nuclear Medicine (B.N.M.v.B.), VU University Medical Center, Amsterdam; and Department of Psychiatry and Neuropsychology (P.J.V.), Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands
| | - Ian Law
- From the Alzheimer Center & Department of Neurology (M.D.Z., F.H.B., P.J.V.) and Department of Clinical Chemistry (C.E.T.), Neuroscience Campus Amsterdam, VU University Medical Center, the Netherlands; Turku PET Centre and Department of Neurology (J.O.R.), University of Turku and Turku University Hospital, Finland; Danish Dementia Research Centre (S.G.H.), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of NVS (A.N., S.F.C.), Centre for Alzheimer Research, Translational Alzheimer Neurobiology, Karolinska Institutet, Stockholm; Department of Geriatric Medicine (A.N.), Karolinska University Hospital, Stockholm, Sweden; Memory Unit (A.L., J.F., R.B.), Department of Neurology, Hospital de Sant Pau, Barcelona; CIBERNED (A.L., J.F., R.B.), Center for Network Biomedical Research into Neurodegenerative Diseases, Instituto de Salud Carlos III, Madrid, Spain; Institute of Clinical Medicine-Neurology (S.-K.H., H.S., J.M.C.B.), University of Eastern Finland, Kuopio; Department of Clinical Physiology (I.L.), Nuclear Medicine and PET, Rigshospitalet, Copenhagen; Department of Autoimmunology and Biomarkers (J.M.C.B.), Statens Serum Institut, Copenhagen, Denmark; Wolfson Molecular Imaging Centre (S.F.C.), Institute of Brain Behaviour and Mental Health, University of Manchester, UK; Department of Radiology & Nuclear Medicine (B.N.M.v.B.), VU University Medical Center, Amsterdam; and Department of Psychiatry and Neuropsychology (P.J.V.), Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands
| | - Justyna M C Bahl
- From the Alzheimer Center & Department of Neurology (M.D.Z., F.H.B., P.J.V.) and Department of Clinical Chemistry (C.E.T.), Neuroscience Campus Amsterdam, VU University Medical Center, the Netherlands; Turku PET Centre and Department of Neurology (J.O.R.), University of Turku and Turku University Hospital, Finland; Danish Dementia Research Centre (S.G.H.), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of NVS (A.N., S.F.C.), Centre for Alzheimer Research, Translational Alzheimer Neurobiology, Karolinska Institutet, Stockholm; Department of Geriatric Medicine (A.N.), Karolinska University Hospital, Stockholm, Sweden; Memory Unit (A.L., J.F., R.B.), Department of Neurology, Hospital de Sant Pau, Barcelona; CIBERNED (A.L., J.F., R.B.), Center for Network Biomedical Research into Neurodegenerative Diseases, Instituto de Salud Carlos III, Madrid, Spain; Institute of Clinical Medicine-Neurology (S.-K.H., H.S., J.M.C.B.), University of Eastern Finland, Kuopio; Department of Clinical Physiology (I.L.), Nuclear Medicine and PET, Rigshospitalet, Copenhagen; Department of Autoimmunology and Biomarkers (J.M.C.B.), Statens Serum Institut, Copenhagen, Denmark; Wolfson Molecular Imaging Centre (S.F.C.), Institute of Brain Behaviour and Mental Health, University of Manchester, UK; Department of Radiology & Nuclear Medicine (B.N.M.v.B.), VU University Medical Center, Amsterdam; and Department of Psychiatry and Neuropsychology (P.J.V.), Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands
| | - Stephen F Carter
- From the Alzheimer Center & Department of Neurology (M.D.Z., F.H.B., P.J.V.) and Department of Clinical Chemistry (C.E.T.), Neuroscience Campus Amsterdam, VU University Medical Center, the Netherlands; Turku PET Centre and Department of Neurology (J.O.R.), University of Turku and Turku University Hospital, Finland; Danish Dementia Research Centre (S.G.H.), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of NVS (A.N., S.F.C.), Centre for Alzheimer Research, Translational Alzheimer Neurobiology, Karolinska Institutet, Stockholm; Department of Geriatric Medicine (A.N.), Karolinska University Hospital, Stockholm, Sweden; Memory Unit (A.L., J.F., R.B.), Department of Neurology, Hospital de Sant Pau, Barcelona; CIBERNED (A.L., J.F., R.B.), Center for Network Biomedical Research into Neurodegenerative Diseases, Instituto de Salud Carlos III, Madrid, Spain; Institute of Clinical Medicine-Neurology (S.-K.H., H.S., J.M.C.B.), University of Eastern Finland, Kuopio; Department of Clinical Physiology (I.L.), Nuclear Medicine and PET, Rigshospitalet, Copenhagen; Department of Autoimmunology and Biomarkers (J.M.C.B.), Statens Serum Institut, Copenhagen, Denmark; Wolfson Molecular Imaging Centre (S.F.C.), Institute of Brain Behaviour and Mental Health, University of Manchester, UK; Department of Radiology & Nuclear Medicine (B.N.M.v.B.), VU University Medical Center, Amsterdam; and Department of Psychiatry and Neuropsychology (P.J.V.), Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands
| | - Juan Fortea
- From the Alzheimer Center & Department of Neurology (M.D.Z., F.H.B., P.J.V.) and Department of Clinical Chemistry (C.E.T.), Neuroscience Campus Amsterdam, VU University Medical Center, the Netherlands; Turku PET Centre and Department of Neurology (J.O.R.), University of Turku and Turku University Hospital, Finland; Danish Dementia Research Centre (S.G.H.), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of NVS (A.N., S.F.C.), Centre for Alzheimer Research, Translational Alzheimer Neurobiology, Karolinska Institutet, Stockholm; Department of Geriatric Medicine (A.N.), Karolinska University Hospital, Stockholm, Sweden; Memory Unit (A.L., J.F., R.B.), Department of Neurology, Hospital de Sant Pau, Barcelona; CIBERNED (A.L., J.F., R.B.), Center for Network Biomedical Research into Neurodegenerative Diseases, Instituto de Salud Carlos III, Madrid, Spain; Institute of Clinical Medicine-Neurology (S.-K.H., H.S., J.M.C.B.), University of Eastern Finland, Kuopio; Department of Clinical Physiology (I.L.), Nuclear Medicine and PET, Rigshospitalet, Copenhagen; Department of Autoimmunology and Biomarkers (J.M.C.B.), Statens Serum Institut, Copenhagen, Denmark; Wolfson Molecular Imaging Centre (S.F.C.), Institute of Brain Behaviour and Mental Health, University of Manchester, UK; Department of Radiology & Nuclear Medicine (B.N.M.v.B.), VU University Medical Center, Amsterdam; and Department of Psychiatry and Neuropsychology (P.J.V.), Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands
| | - Rafael Blesa
- From the Alzheimer Center & Department of Neurology (M.D.Z., F.H.B., P.J.V.) and Department of Clinical Chemistry (C.E.T.), Neuroscience Campus Amsterdam, VU University Medical Center, the Netherlands; Turku PET Centre and Department of Neurology (J.O.R.), University of Turku and Turku University Hospital, Finland; Danish Dementia Research Centre (S.G.H.), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of NVS (A.N., S.F.C.), Centre for Alzheimer Research, Translational Alzheimer Neurobiology, Karolinska Institutet, Stockholm; Department of Geriatric Medicine (A.N.), Karolinska University Hospital, Stockholm, Sweden; Memory Unit (A.L., J.F., R.B.), Department of Neurology, Hospital de Sant Pau, Barcelona; CIBERNED (A.L., J.F., R.B.), Center for Network Biomedical Research into Neurodegenerative Diseases, Instituto de Salud Carlos III, Madrid, Spain; Institute of Clinical Medicine-Neurology (S.-K.H., H.S., J.M.C.B.), University of Eastern Finland, Kuopio; Department of Clinical Physiology (I.L.), Nuclear Medicine and PET, Rigshospitalet, Copenhagen; Department of Autoimmunology and Biomarkers (J.M.C.B.), Statens Serum Institut, Copenhagen, Denmark; Wolfson Molecular Imaging Centre (S.F.C.), Institute of Brain Behaviour and Mental Health, University of Manchester, UK; Department of Radiology & Nuclear Medicine (B.N.M.v.B.), VU University Medical Center, Amsterdam; and Department of Psychiatry and Neuropsychology (P.J.V.), Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands
| | - Charlotte E Teunissen
- From the Alzheimer Center & Department of Neurology (M.D.Z., F.H.B., P.J.V.) and Department of Clinical Chemistry (C.E.T.), Neuroscience Campus Amsterdam, VU University Medical Center, the Netherlands; Turku PET Centre and Department of Neurology (J.O.R.), University of Turku and Turku University Hospital, Finland; Danish Dementia Research Centre (S.G.H.), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of NVS (A.N., S.F.C.), Centre for Alzheimer Research, Translational Alzheimer Neurobiology, Karolinska Institutet, Stockholm; Department of Geriatric Medicine (A.N.), Karolinska University Hospital, Stockholm, Sweden; Memory Unit (A.L., J.F., R.B.), Department of Neurology, Hospital de Sant Pau, Barcelona; CIBERNED (A.L., J.F., R.B.), Center for Network Biomedical Research into Neurodegenerative Diseases, Instituto de Salud Carlos III, Madrid, Spain; Institute of Clinical Medicine-Neurology (S.-K.H., H.S., J.M.C.B.), University of Eastern Finland, Kuopio; Department of Clinical Physiology (I.L.), Nuclear Medicine and PET, Rigshospitalet, Copenhagen; Department of Autoimmunology and Biomarkers (J.M.C.B.), Statens Serum Institut, Copenhagen, Denmark; Wolfson Molecular Imaging Centre (S.F.C.), Institute of Brain Behaviour and Mental Health, University of Manchester, UK; Department of Radiology & Nuclear Medicine (B.N.M.v.B.), VU University Medical Center, Amsterdam; and Department of Psychiatry and Neuropsychology (P.J.V.), Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands
| | - Femke H Bouwman
- From the Alzheimer Center & Department of Neurology (M.D.Z., F.H.B., P.J.V.) and Department of Clinical Chemistry (C.E.T.), Neuroscience Campus Amsterdam, VU University Medical Center, the Netherlands; Turku PET Centre and Department of Neurology (J.O.R.), University of Turku and Turku University Hospital, Finland; Danish Dementia Research Centre (S.G.H.), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of NVS (A.N., S.F.C.), Centre for Alzheimer Research, Translational Alzheimer Neurobiology, Karolinska Institutet, Stockholm; Department of Geriatric Medicine (A.N.), Karolinska University Hospital, Stockholm, Sweden; Memory Unit (A.L., J.F., R.B.), Department of Neurology, Hospital de Sant Pau, Barcelona; CIBERNED (A.L., J.F., R.B.), Center for Network Biomedical Research into Neurodegenerative Diseases, Instituto de Salud Carlos III, Madrid, Spain; Institute of Clinical Medicine-Neurology (S.-K.H., H.S., J.M.C.B.), University of Eastern Finland, Kuopio; Department of Clinical Physiology (I.L.), Nuclear Medicine and PET, Rigshospitalet, Copenhagen; Department of Autoimmunology and Biomarkers (J.M.C.B.), Statens Serum Institut, Copenhagen, Denmark; Wolfson Molecular Imaging Centre (S.F.C.), Institute of Brain Behaviour and Mental Health, University of Manchester, UK; Department of Radiology & Nuclear Medicine (B.N.M.v.B.), VU University Medical Center, Amsterdam; and Department of Psychiatry and Neuropsychology (P.J.V.), Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands
| | - Bart N M van Berckel
- From the Alzheimer Center & Department of Neurology (M.D.Z., F.H.B., P.J.V.) and Department of Clinical Chemistry (C.E.T.), Neuroscience Campus Amsterdam, VU University Medical Center, the Netherlands; Turku PET Centre and Department of Neurology (J.O.R.), University of Turku and Turku University Hospital, Finland; Danish Dementia Research Centre (S.G.H.), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of NVS (A.N., S.F.C.), Centre for Alzheimer Research, Translational Alzheimer Neurobiology, Karolinska Institutet, Stockholm; Department of Geriatric Medicine (A.N.), Karolinska University Hospital, Stockholm, Sweden; Memory Unit (A.L., J.F., R.B.), Department of Neurology, Hospital de Sant Pau, Barcelona; CIBERNED (A.L., J.F., R.B.), Center for Network Biomedical Research into Neurodegenerative Diseases, Instituto de Salud Carlos III, Madrid, Spain; Institute of Clinical Medicine-Neurology (S.-K.H., H.S., J.M.C.B.), University of Eastern Finland, Kuopio; Department of Clinical Physiology (I.L.), Nuclear Medicine and PET, Rigshospitalet, Copenhagen; Department of Autoimmunology and Biomarkers (J.M.C.B.), Statens Serum Institut, Copenhagen, Denmark; Wolfson Molecular Imaging Centre (S.F.C.), Institute of Brain Behaviour and Mental Health, University of Manchester, UK; Department of Radiology & Nuclear Medicine (B.N.M.v.B.), VU University Medical Center, Amsterdam; and Department of Psychiatry and Neuropsychology (P.J.V.), Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands
| | - Pieter J Visser
- From the Alzheimer Center & Department of Neurology (M.D.Z., F.H.B., P.J.V.) and Department of Clinical Chemistry (C.E.T.), Neuroscience Campus Amsterdam, VU University Medical Center, the Netherlands; Turku PET Centre and Department of Neurology (J.O.R.), University of Turku and Turku University Hospital, Finland; Danish Dementia Research Centre (S.G.H.), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of NVS (A.N., S.F.C.), Centre for Alzheimer Research, Translational Alzheimer Neurobiology, Karolinska Institutet, Stockholm; Department of Geriatric Medicine (A.N.), Karolinska University Hospital, Stockholm, Sweden; Memory Unit (A.L., J.F., R.B.), Department of Neurology, Hospital de Sant Pau, Barcelona; CIBERNED (A.L., J.F., R.B.), Center for Network Biomedical Research into Neurodegenerative Diseases, Instituto de Salud Carlos III, Madrid, Spain; Institute of Clinical Medicine-Neurology (S.-K.H., H.S., J.M.C.B.), University of Eastern Finland, Kuopio; Department of Clinical Physiology (I.L.), Nuclear Medicine and PET, Rigshospitalet, Copenhagen; Department of Autoimmunology and Biomarkers (J.M.C.B.), Statens Serum Institut, Copenhagen, Denmark; Wolfson Molecular Imaging Centre (S.F.C.), Institute of Brain Behaviour and Mental Health, University of Manchester, UK; Department of Radiology & Nuclear Medicine (B.N.M.v.B.), VU University Medical Center, Amsterdam; and Department of Psychiatry and Neuropsychology (P.J.V.), Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands
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Arbizu J, García-Ribas G, Carrió I, Garrastachu P, Martínez-Lage P, Molinuevo JL. Recommendations for the use of PET imaging biomarkers in the diagnosis of neurodegenerative conditions associated with dementia: consensus proposal from the SEMNIM and SEN. Rev Esp Med Nucl Imagen Mol 2015. [DOI: 10.1016/j.remnie.2015.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Arbizu J, García-Ribas G, Carrió I, Garrastachu P, Martínez-Lage P, Molinuevo JL. Recommendations for the use of PET imaging biomarkers in the diagnosis of neurodegenerative conditions associated with dementia: SEMNIM and SEN consensus. Rev Esp Med Nucl Imagen Mol 2015; 34:303-13. [PMID: 26099942 DOI: 10.1016/j.remn.2015.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 03/10/2015] [Indexed: 10/23/2022]
Abstract
The new diagnostic criteria for Alzheimer's disease (AD) acknowledges the interest given to biomarkers to improve the specificity in subjects with dementia and to facilitate an early diagnosis of the pathophysiological process of AD in the prodromal or pre-dementia stage. The current availability of PET imaging biomarkers of synaptic dysfunction (PET-FDG) and beta amyloid deposition using amyloid-PET provides clinicians with the opportunity to apply the new criteria and improve diagnostic accuracy in their clinical practice. Therefore, it seems essential for the scientific societies involved to use the new clinical diagnostic support tools to establish clear, evidence-based and agreed set of recommendations for their appropriate use. The present work includes a systematic review of the literature on the utility of FDG-PET and amyloid-PET for the diagnosis of AD and related neurodegenerative diseases that occur with dementia. Thus, we propose a series of recommendations agreed on by the Spanish Society of Nuclear Medicine and Spanish Society of Neurology as a consensus statement on the appropriate use of PET imaging biomarkers.
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Affiliation(s)
- Javier Arbizu
- Servicio de Medicina Nuclear, Clínica Universidad de Navarra, Pamplona, España.
| | | | - Ignasi Carrió
- Servicio de Medicina Nuclear, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Puy Garrastachu
- Servicio de Medicina Nuclear, Hospital San Pedro y Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, España
| | - Pablo Martínez-Lage
- Neurología Fundación CITA-Alzhéimer Fundazioa, Centro de Investigación y Terapias Avanzadas, San Sebastián, España
| | - José Luis Molinuevo
- Unidad de Enfermedad de Alzheimer y Otros Trastornos Cognitivos, Servicio de Neurología, Hospital Clinic i Universitari ICN y Fundación Pasqual Maragall, Barcelona, España
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Abstract
Development of molecular imaging agents for fibrillar β-amyloid positron-emission tomography during the past decade has brought molecular imaging of Alzheimer disease pathology into the spotlight. Large cohort studies with longitudinal follow-up in cognitively normal individuals and patients with mild cognitive impairment and Alzheimer disease indicate that β-amyloid deposition can be detected many years before the onset of symptoms with molecular imaging, and its progression can be followed longitudinally. The utility of β-amyloid PET in the differential diagnosis of Alzheimer disease is greatest when there is no pathologic overlap between 2 dementia syndromes, such as in frontotemporal lobar degeneration and Alzheimer disease. However β-amyloid PET alone may be insufficient in distinguishing dementia syndromes that commonly have overlapping β-amyloid pathology, such as dementia with Lewy bodies and vascular dementia, which represent the 2 most common dementia pathologies after Alzheimer disease. The role of molecular imaging in Alzheimer disease clinical trials is growing rapidly, especially in an era when preventive interventions are designed to eradicate the pathology targeted by molecular imaging agents.
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Affiliation(s)
- K Kantarci
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota.
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Sánchez-Juan P, Ghosh PM, Hagen J, Gesierich B, Henry M, Grinberg LT, O'Neil JP, Janabi M, Huang EJ, Trojanowski JQ, Vinters HV, Gorno-Tempini M, Seeley WW, Boxer AL, Rosen HJ, Kramer JH, Miller BL, Jagust WJ, Rabinovici GD. Practical utility of amyloid and FDG-PET in an academic dementia center. Neurology 2013; 82:230-8. [PMID: 24353340 DOI: 10.1212/wnl.0000000000000032] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the effect of amyloid imaging on clinical decision making. METHODS We conducted a retrospective analysis of 140 cognitively impaired patients (mean age 65.0 years, 46% primary β-amyloid (Aβ) diagnosis, mean Mini-Mental State Examination 22.3) who underwent amyloid (Pittsburgh compound B [PiB]) PET as part of observational research studies and were evaluated clinically before and after the scan. One hundred thirty-four concurrently underwent fluorodeoxyglucose (FDG)-PET. We assessed for changes between the pre- and post-PET clinical diagnosis (from Aβ to non-Aβ diagnosis or vice versa) and Alzheimer disease treatment plan. The association between PiB/FDG results and changes in management was evaluated using χ(2) and multivariate logistic regression. Postmortem diagnosis was available for 24 patients (17%). RESULTS Concordance between scan results and baseline diagnosis was high (PiB 84%, FDG 82%). The primary diagnosis changed after PET in 13/140 patients (9%) overall but in 5/13 (38%) patients considered pre-PET diagnostic dilemmas. When examined independently, discordant PiB and discordant FDG were both associated with diagnostic change (unadjusted p < 0.0001). However, when examined together in a multivariate logistic regression, only discordant PiB remained significant (adjusted p = 0.00013). Changes in treatment were associated with discordant PiB in patients with non-Aβ diagnoses (adjusted p = 0.028), while FDG had no effect on therapy. Both PiB (96%) and FDG (91%) showed high agreement with autopsy diagnosis. CONCLUSIONS PET had a moderate effect on clinical outcomes. Discordant PiB had a greater effect than discordant FDG, and influence on diagnosis was greater than on treatment. Prospective studies are needed to better characterize the clinical role of amyloid PET.
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Affiliation(s)
- Pascual Sánchez-Juan
- From the Memory and Aging Center and Department of Neurology (P.S.-J., P.M.G., J.H., B.G., M.H., L.T.G., M.G.-T., W.W.S., A.L.B., H.J.R., J.H.K., B.L.M.,W.J.J., G.D.R.) and Department of Pathology and Laboratory Medicine (E.J.H.), University of California, San Francisco; University Hospital "Marqués de Valdecilla," IFIMAV and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (P.S.-J.), Santander, Spain; Helen Wills Neuroscience Institute (P.M.G., W.J.J., G.D.R.), University of California, Berkeley; Lawrence Berkeley National Laboratory (P.M.G., J.P.O., M.J., W.J.J., G.D.R.), Berkeley, CA; Center for Neurodegenerative Research (J.Q.T.), University of Pennsylvania, Philadelphia; and Department of Pathology and Laboratory Medicine (H.V.V.), University of California, Los Angeles
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Degerman Gunnarsson M, Lindau M, Santillo AF, Wall A, Engler H, Lannfelt L, Basun H, Kilander L. Re-evaluation of clinical dementia diagnoses with pittsburgh compound B positron emission tomography. Dement Geriatr Cogn Dis Extra 2013; 3:472-81. [PMID: 24516415 PMCID: PMC3919484 DOI: 10.1159/000356273] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Objectives There is an overlap regarding Pittsburgh compound B (PIB) retention in patients clinically diagnosed as Alzheimer's disease (AD) and non-AD dementia. The aim of the present study was to investigate whether there are any differences between PIB-positive and PIB-negative patients in a mixed cohort of patients with neurodegenerative dementia of mild severity regarding neuropsychological test performance and regional cerebral glucose metabolism measured with [18F]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET). Methods Eighteen patients clinically diagnosed as probable AD or frontotemporal dementia were examined with PIB PET, FDG PET and neuropsychological tests and followed for 5-9 years in a clinical setting. Results The PIB-positive patients (7 out of 18) had slower psychomotor speed and more impaired visual episodic memory than the PIB-negative patients; otherwise performance did not differ between the groups. The initial clinical diagnoses were changed in one third of the patients (6 out of 18) during follow-up. Conclusions The subtle differences in neuropsychological performance, the overlap of hypometabolic patterns and clinical features between AD and non-AD dementia highlight the need for amyloid biomarkers and a readiness to re-evaluate the initial diagnosis.
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Affiliation(s)
- M Degerman Gunnarsson
- Department of Public Health/Geriatrics, Uppsala University, Uppsala, Stockholm, Sweden
| | - M Lindau
- Department of Public Health/Geriatrics, Uppsala University, Uppsala, Stockholm, Sweden ; Department of Psychology, Stockholm University, Stockholm, Stockholm, Sweden
| | - A F Santillo
- Geriatric Psychiatry, Department of Clinical Medicine, Lund University, Lund, Stockholm, Sweden
| | - A Wall
- Section of Nuclear Medicine and PET, Department of Radiology, Oncology and Radiation Sciences, Uppsala University, Uppsala, Stockholm, Sweden
| | - H Engler
- Faculty of Medicine and Faculty of Science, University of the Republic Uruguay, Montevideo, Uruguay
| | - L Lannfelt
- Department of Public Health/Geriatrics, Uppsala University, Uppsala, Stockholm, Sweden
| | - H Basun
- Department of Public Health/Geriatrics, Uppsala University, Uppsala, Stockholm, Sweden ; BioArctic Neuroscience AB, Stockholm, Sweden
| | - L Kilander
- Department of Public Health/Geriatrics, Uppsala University, Uppsala, Stockholm, Sweden
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Foster NL, Jagust WJ, Fox NC. A peek behind the curtain: amyloid imaging, referrals, and specialist memory evaluations. Alzheimer Dis Assoc Disord 2013; 27:1-3. [PMID: 23411640 DOI: 10.1097/wad.0b013e31828ab5d8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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