Monday, May 8, 2023

Early PET Scans Improve Confidence When Diagnosing Cognitive Problems

Adults who receive a positron emission tomography (PET) scan to measure brain amyloid levels shortly after seeing a doctor for cognitive problems are more likely to be confidently diagnosed within three months than those whose PET scans are delayed, suggests a study published today in JAMA Neurology.

“Amyloid deposition in the brain is one of the main hallmarks of Alzheimer disease (AD) and is considered one of the strongest risk factors of dementia,” wrote Daniele Altomare, Ph.D., of Geneva Memory Center in Switzerland and colleagues. “This evidence from [the Amyloid Imaging to Prevent Alzheimer’s Disease Diagnostic and Patient Management Study] of the clinical effect of amyloid PET in a European memory clinic population suggests that widespread implementation of this imaging technique may improve the timely diagnostic workup of patients under evaluation for cognitive decline.”

Altomare and colleagues enrolled 840 older adults (median age 71) from eight memory clinics across Europe in the study. The participants had varied stages of cognitive problems, ranging from subjective cognitive decline to mild cognitive impairment to dementia. The participants were then placed in one of three assessment groups:

  • Group 1 participants received an amyloid PET scan within one month of their baseline clinical visit.
  • Group 2 participants received an amyloid PET scan about eight months after their baseline visit.
  • Group 3 participants received a PET scan at the direction of the physician managing their care (free choice group).

The researchers then compared how many participants in groups 1 and 2 received a very high-confidence diagnosis of their condition (physician was 90% sure or better of being correct) at a follow-up visit three months after the baseline assessment. At three months, 40% (109 of 272) of participants in group 1 had a diagnosis with very high confidence compared with 11% (30 of 260) in group 2. This diagnostic improvement was seen in participants across all three cognitive stages (subjective cognitive decline, mild cognitive impairment, and dementia).

The researchers noted that given free choice, physicians frequently requested an amyloid PET early in the diagnostic evaluation. Almost 70% of participants in group 3 received a PET scan before the three-month follow-up visit, and 37% of group 3 participants received a diagnosis with very high confidence.

“A timely high-confidence diagnosis is critical to the efficacy of disease-modifying therapies, especially anti-amyloid drugs, whose efficacy might decrease with advancing disease progression,” the authors concluded.

To read more about this topic, see the Psychiatric News article “FDA Clears First In Vitro Assay to Improve Alzheimer’s Diagnosis.”

(Image: iStock/bawanch)

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