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

• Published in: Medicine (Baltimore) Vol. 98; no. 29; p. e16509
• Main Authors: Triviño-Ibáñez, Eva María, Sánchez-Vañó, Raquel, Sopena-Novales, Pablo, Romero-Fábrega, Juan Carlos, Rodríguez-Fernández, Antonio, Carnero Pardo, Cristóbal, Martínez Lozano, María Dolores, Gómez-Río, Manuel
• Format: Journal Article
• Language: English
• Published: United States the Author(s). Published by Wolters Kluwer Health, Inc 01-07-2019; Wolters Kluwer Health
• Subjects: Aged; Alzheimer Disease - diagnostic imaging; Alzheimer Disease - drug therapy; Cognitive Dysfunction - diagnostic imaging; Cognitive Dysfunction - drug therapy; Female; Humans; Male; Middle Aged; Observational Study; Plaque, Amyloid - diagnostic imaging; Positron-Emission Tomography - methods; Prospective Studies
• ISSN: 0025-7974; 1536-5964
• DOI: 10.1097/MD.0000000000016509

To evaluate the use of amyloid-positron emission tomography (PET) in routine clinical practice, in a selected population with cognitive impairment that meets appropriate use criteria (AUC).A multicenter, observational, prospective case-series study of 211patients from 2 level-3 hospitals who fulfilled clinical AUC for amyloid-PET scan in a naturalistic setting. Certainty degree was evaluated using a 5-point Likert scale: 0 (very low probability); 1 (low probability); 2 (intermediate probability); 3 (high probability); and 4 (practically sure), before and after amyloid PET. The treatment plan was considered as cognition-specific or noncognition-specific.Amyloid-PET was positive in 118 patients (55.9%) and negative in 93 patients (44.1%). Diagnostic prescan confidence according amyloid-PET results showed that in both, negative and positive-PET subgroup, the most frequent category was intermediate probability (45.7% and 55.1%, respectively). After the amyloid-PET, the diagnostic confidence showed a very different distribution, that was, in the negative-PET group the most frequent categories are very unlikely (70.7%) and unlikely (29.3%), while in the positive-PET group were very probable (57.6%) and practically sure (39%). Only in 14/211 patients (6.6%) the result of the amyloid-PET did not influence the diagnostic confidence, while in 194 patients (93.4%), the diagnostic confidence improved significantly after amyloid-PET results. The therapeutic intention was modified in 93 patients (44.1%). Specific treatment for Alzheimer disease was started, before amyloid-PET, in 80 patients (37.9%).This naturalistic study provides evidence that the implementation of amyloid-PET is associated with a significant improvement in diagnostic confidence and has a high impact on the therapeutic management of patients with mild cognitive impairment fulfilled clinical AUC.