Dementia Management, Diagnosis Often Changes Following Amyloid PET

Nearly two-thirds of patients with mild cognitive impairment (MCI) or dementia of uncertain cause who undergo amyloid positron emission tomography (PET) see changes to their clinical management within 90 days, according to the results of a recent study.

In order to examine whether amyloid PET is associated with subsequent changes in the management of patients with MCI or dementia of unknown etiology, the researchers conducted a single-group, multisite longitudinal study involving 16,008 patients with cognitive impairment. Dementia specialists documented the patients’ management plans before and after PET.

The primary outcome included changes to Alzheimer disease drug therapy, other drug therapy, and counseling about safety and future planning. Secondary endpoints included change in changes in diagnosis.

Overall, 11,409 of the participants were included in the final analysis. Results of Amyloid PET were positive in 3817 patients with MCI (55.3%) and 3154 patients with dementia (70.1%). A change in the composite end point was observed in 4159 of the 6905 patients with MCI (60.2%) and 2859 of 4504 patients with dementia (63.5%).

Further, diagnosis changed from Alzheimer disease to non-Alzheimer disease in 2860 of 11,409 patients (25.1%) and from non-Alzheimer disease to Alzheimer disease in 1201 of 11,409 patients (10.5%).

“Among Medicare beneficiaries with MCI or dementia of uncertain etiology evaluated by dementia specialists, the use of amyloid PET was associated with changes in clinical management within 90 days. Further research is needed to determine whether amyloid PET is associated with improved clinical outcomes,” the researchers concluded.

—Michael Potts

Reference:

Rabinovici GD, Gatsonis C, Apgar C, et al. Association of amyloid positron emission tomography with subsequent change in clinical management among medicare beneficiaries with mild cognitive impairment or dementia. JAMA. 2019;321(13):1286-1294.