scholarly journals Effect of Amyloid Imaging on the Diagnosis and Management of Patients with Cognitive Decline: Impact of Appropriate Use Criteria

2016 ◽  
Vol 41 (1-2) ◽  
pp. 80-92 ◽  
Author(s):  
Michael Grundman ◽  
Keith A. Johnson ◽  
Ming Lu ◽  
Andrew Siderowf ◽  
Grazia Dell''Agnello ◽  
...  
Keyword(s):  
Cognitive Decline ◽  
Management Plan ◽  
Amyloid Imaging ◽  
Amyloid Pet ◽  
Appropriate Use Criteria ◽  
Appropriate Use ◽  
Diagnosis And Management ◽  
Positron Emission ◽  
Before And After ◽  
The Impact

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.

O4-01-02: EFFECT OF AMYLOID IMAGING ON DIAGNOSIS AND MANAGEMENT OF PATIENTS WITH COGNITIVE DECLINE: IMPACT OF APPROPRIATE USE CRITERIA

2014 ◽  
Vol 10 ◽  
pp. P248-P249
Author(s):  
Andrew Siderowf ◽  
Michael Pontecorvo ◽  
Adam S. Fleisher ◽  
Anil K. Nair ◽  
Ming Lu ◽  
...  
Keyword(s):  
Cognitive Decline ◽  
Amyloid Imaging ◽  
Appropriate Use Criteria ◽  
Appropriate Use ◽  
Diagnosis And Management

Quantitative appraisal of the Amyloid Imaging Taskforce appropriate use criteria for amyloid-PET

2018 ◽  
Vol 14 (8) ◽  
pp. 1088-1098 ◽  
Author(s):  
Daniele Altomare ◽  
Clarissa Ferrari ◽  
Cristina Festari ◽  
Ugo Paolo Guerra ◽  
Cristina Muscio ◽  
...  
Keyword(s):  
Amyloid Imaging ◽  
Amyloid Pet ◽  
Appropriate Use Criteria ◽  
Appropriate Use ◽  
Quantitative Appraisal

scholarly journals Appropriate use criteria for amyloid PET: A report of the Amyloid Imaging Task Force, the Society of Nuclear Medicine and Molecular Imaging, and the Alzheimer's Association

2013 ◽  
Vol 9 (1) ◽  
pp. E1-E16 ◽  
Author(s):  
Keith A. Johnson ◽  
Satoshi Minoshima ◽  
Nicolaas I. Bohnen ◽  
Kevin J. Donohoe ◽  
Norman L. Foster ◽  
...  
Keyword(s):  
Nuclear Medicine ◽  
Molecular Imaging ◽  
Task Force ◽  
Amyloid Imaging ◽  
Amyloid Pet ◽  
Appropriate Use Criteria ◽  
Appropriate Use

scholarly journals Potential effect of amyloid imaging on diagnosis and intended management of patients with cognitive decline: impact of appropriate use criterion

2015 ◽  
Vol 42 (S1) ◽  
pp. S10-S10 ◽  
Author(s):  
G Dell’Agnello ◽  
MJ Pontecorvo ◽  
A Siderowf ◽  
M Lu ◽  
C Hunter ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Decline ◽  
Potential Effect ◽  
Amyloid Pet ◽  
Appropriate Use ◽  
Provisional Diagnosis ◽  
Objective Evidence ◽  
The Impact ◽  
Mci Due To Ad

Background: Appropriate use criteria (AUC; Johnson et al, 2013) provide guidelines for selecting patients for whom amyloid PET could be useful. This study evaluated the impact of amyloid PET on diagnosis/management in patients likely to meet AUC. Methods: We examined 229 cases from a completed study of florbetapir amyloid PET (FBP-PET) in patients with a cognitive decline evaluation in whom Alzheimer’s Disease (AD) was suspected, but with <85% confidence in the diagnosis. All cases received a provisional diagnosis and management prior to FBP-PET. Information for 172 cases after 3-months’ follow-up was also available on actual diagnosis/management post-FBP-PET. Cases were classified as likely meeting AUC (AUC-like) or not. Results: 125/229(55%) subjects were AUC-like. NonAUC cases included typical AD, Mild Cognitive Impairment (MCI) due to AD, Cognitive Decline without objective evidence of impairment (CD) and dementia or cognitive impairment with specific nonAD diagnosis. 59/125(47%) AUC-like cases were amyloid positive (Aβ+). Among nonAUC cases, 29% (CD), 49%(MCI due to AD), 53%(non-AD) and 73%(typical AD) were Aβ+. Of 172 cases with follow-up information, diagnosis/management changed after FBP-PET in 58%/88% and 45%/77% of AUC-like and nonAUC, respectively. Conclusions: FBP-PET altered diagnosis/management in patients selected according to AUC. Additionally, AUC generally excluded patients with a relatively high (typical AD) or low (CD) probability of Aβ+ scan.

scholarly journals Cognitive trajectories of patients with focal ß-amyloid deposition

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Si Eun Kim ◽  
Byungju Lee ◽  
Hyemin Jang ◽  
Juhee Chin ◽  
Ching Soong Khoo ◽  
...  
Keyword(s):  
Cognitive Decline ◽  
Neuropsychological Tests ◽  
Mixed Effects ◽  
Amnestic Mild Cognitive Impairment ◽  
Emission Tomography ◽  
Amyloid Pet ◽  
Cognitive Level ◽  
Visual Rating ◽  
Positron Emission ◽  
The Brain

Abstract Background The presence of ß-amyloid (Aß) in the brain can be identified using amyloid PET. In clinical practice, the amyloid PET is interpreted based on dichotomous visual rating, which renders focal Aß accumulation be read as positive for Aß. However, the prognosis of patients with focal Aß deposition is not well established. Thus, we investigated cognitive trajectories of patients with focal Aß deposition. Methods We followed up 240 participants (112 cognitively unimpaired [CU], 78 amnestic mild cognitive impairment [aMCI], and 50 Alzheimer’s disease (AD) dementia [ADD]) for 2 years from 9 referral centers in South Korea. Participants were assessed with neuropsychological tests and 18F-flutemetamol (FMM) positron emission tomography (PET). Ten regions (frontal, precuneus/posterior cingulate (PPC), lateral temporal, parietal, and striatum of each hemisphere) were visually examined in the FMM scan, and participants were divided into three groups: No-FMM, Focal-FMM (FMM uptake in 1–9 regions), and Diffuse-FMM. We used mixed-effects model to investigate the speed of cognitive decline in the Focal-FMM group according to the cognitive level, extent, and location of Aß involvement, in comparison with the No- or Diffuse-FMM group. Results Forty-five of 240 (18.8%) individuals were categorized as Focal-FMM. The rate of cognitive decline in the Focal-FMM group was faster than the No-FMM group (especially in the CU and aMCI stage) and slower than the Diffuse-FMM group (in particular in the CU stage). Within the Focal-FMM group, participants with FMM uptake to a larger extent (7–9 regions) showed faster cognitive decline compared to those with uptake to a smaller extent (1–3 or 4–6 regions). The Focal-FMM group was found to have faster cognitive decline in comparison with the No-FMM when there was uptake in the PPC, striatum, and frontal cortex. Conclusions When predicting cognitive decline of patients with focal Aß deposition, the patients’ cognitive level, extent, and location of the focal involvement are important.

scholarly journals Impact of amyloid-PET in daily clinical management of patients with cognitive impairment fulfilling appropriate use criteria

Medicine ◽  
2019 ◽  
Vol 98 (29) ◽  
pp. e16509
Author(s):  
Eva María Triviño-Ibáñez ◽  
Raquel Sánchez-Vañó ◽  
Pablo Sopena-Novales ◽  
Juan Carlos Romero-Fábrega ◽  
Antonio Rodríguez-Fernández ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Clinical Management ◽  
Amyloid Pet ◽  
Appropriate Use Criteria ◽  
Appropriate Use

Usefulness of Dual-Point Amyloid PET Scans in Appropriate Use Criteria: A Multicenter Study

2018 ◽  
Vol 65 (3) ◽  
pp. 765-779 ◽  
Author(s):  
Fermín Segovia ◽  
Manuel Gómez-Río ◽  
Raquel Sánchez-Vañó ◽  
Juan Manuel Górriz ◽  
Javier Ramírez ◽  
...  
Keyword(s):  
Multicenter Study ◽  
Amyloid Pet ◽  
Appropriate Use Criteria ◽  
Appropriate Use ◽  
Pet Scans

Amyloid imaging in Alzheimer’s disease: a potential new era of personalized medicine?

2014 ◽  
Vol 5 (1) ◽  
Author(s):  
Antoine Leuzy ◽  
Eduardo Zimmer ◽  
Serge Gauthier ◽  
Pedro Rosa-Neto
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Personalized Medicine ◽  
Amyloid Imaging ◽  
Phase Iii ◽  
Diagnostic Process ◽  
European Medicines Agency ◽  
Amyloid Pet ◽  
Positron Emission

AbstractRecent advances along clinical and neuropathological lines, as well as in our ability to detect the deposition of β-amyloid (Aβ) in vivo using positron emission tomography (PET), have helped redefine Alzheimer’s disease (AD) as a dynamic clinicobiological entity. On the basis of these advances, AD is now conceptualized as a continuum comprising asymptomatic, minimally symptomatic, and dementia phases, with detection of brain Aβ — in particular, via PET amyloid imaging — central to the diagnostic process. In this respect, [18F]florbetapir (Amyvid™) and [18F]flutemetamol (Vizamyl™) have recently received approval for clinical use from the Food and Drug Administration (FDA) and the European Medicines Agency (EMA), with additional radiofluorinated tracers for detection of Aβ in phase III trials. Recent initiatives such as the Alzheimer’s Disease Neuroimaging Initiative (ADNI) suggest that Aβ production, oligomerization and aggregation begins many years, possibly decades, before detectable cognitive impairment, with Aβ shown to associate with cognitive decline and conversion to dementia. While personalized medicine has now emerged as a prospect for the field, the recent decision by the Centers for Medicare & Medicaid Services (CMS) — who declined to cover the cost of amyloid PET imaging citing insufficient evidence to support its clinical utility — highlights that such a move may be premature.

scholarly journals The Who, When, Why, and How of PET Amyloid Imaging in Management of Alzheimer’s Disease—Review of Literature and Interesting Images

Diagnostics ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. 65 ◽  
Author(s):  
Subapriya Suppiah ◽  
Mellanie-Anne Didier ◽  
Sobhan Vinjamuri
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Area Under The Curve ◽  
Standard Uptake Value ◽  
Amyloid Imaging ◽  
Carrier Status ◽  
Amyloid Pet ◽  
Positron Emission ◽  
Cutoff Points ◽  
Pet Amyloid

Amyloid imaging using positron emission tomography (PET) has an emerging role in the management of Alzheimer’s disease (AD). The basis of this imaging is grounded on the fact that the hallmark of AD is the histological detection of beta amyloid plaques (Aβ) at post mortem autopsy. Currently, there are three FDA approved amyloid radiotracers used in clinical practice. This review aims to take the readers through the array of various indications for performing amyloid PET imaging in the management of AD, particularly using 18F-labelled radiopharmaceuticals. We elaborate on PET amyloid scan interpretation techniques, their limitations and potential improved specificity provided by interpretation done in tandem with genetic data such as apolipiprotein E (APO) 4 carrier status in sporadic cases and molecular information (e.g., cerebral spinal fluid (CSF) amyloid levels). We also describe the quantification methods such as the standard uptake value ratio (SUVr) method that utilizes various cutoff points for improved accuracy of diagnosing AD, such as a threshold of 1.122 (area under the curve 0.894), which has a sensitivity of 92.3% and specificity of 90.5%, whereas the cutoff points may be higher in APOE ε4 carriers (1.489) compared to non-carriers (1.313). Additionally, recommendations for future developments in this field are also provided.

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