Association of Amyloid Positron Emission Tomography With Changes in Diagnosis and Patient Treatment in an Unselected Memory Clinic Cohort

Autor: Jurre H. Verwer, Marleen Kunneman, Erik van Lier, Maqsood Yaqub, Andrew Stephens, Frederik Barkhof, Marieke M. van Buchem, Arno de Wilde, Colin Groot, Ellen M. A. Smets, Philip Scheltens, Adriaan A. Lammertsma, Rik Ossenkoppele, Bart N.M. van Berckel, Wiesje M. van der Flier, Marissa D. Zwan, Wiesje Pelkmans, Femke H. Bouwman, Geert Jan Biessels
Přispěvatelé: APH - Quality of Care, Medical Psychology, APH - Personalized Medicine, Amsterdam Neuroscience - Neurodegeneration, Neurology, APH - Methodology, Epidemiology and Data Science, Radiology and nuclear medicine
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Zdroj: JAMA Neurology, 75(9), 1062-1070. American Medical Association
JAMA Neurology, 1062-1070. American Medical Association
STARTPAGE=1062;ENDPAGE=1070;ISSN=2168-6149;TITLE=JAMA Neurology
de Wilde, A, van der Flier, W M, Pelkmans, W, Bouwman, F, Verwer, J, Groot, C, van Buchem, M M, Zwan, M, Ossenkoppele, R, Yaqub, M, Kunneman, M, Smets, E M A, Barkhof, F, Lammertsma, A A, Stephens, A, van Lier, E, Biessels, G J, van Berckel, B N & Scheltens, P 2018, ' Association of Amyloid Positron Emission Tomography With Changes in Diagnosis and Patient Treatment in an Unselected Memory Clinic Cohort : The ABIDE Project ', JAMA Neurology, pp. 1062-1070 . https://doi.org/10.1001/jamaneurol.2018.1346
ISSN: 2168-6149
Popis: 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 65 years) than younger (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.
Databáze: OpenAIRE
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