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Diagnostic impact of [(18)F]flutemetamol PET in early-onset dementia
BACKGROUND: Early-onset dementia patients often present with atypical clinical symptoms, hampering an accurate clinical diagnosis. The purpose of the present study was to assess the diagnostic impact of the amyloid-positron emission tomography (PET) imaging agent [(18)F]flutemetamol in early-onset d...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5240413/ https://www.ncbi.nlm.nih.gov/pubmed/28093088 http://dx.doi.org/10.1186/s13195-016-0228-4 |
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author | Zwan, Marissa D. Bouwman, Femke H. Konijnenberg, Elles van der Flier, Wiesje M. Lammertsma, Adriaan A. Verhey, Frans R. J. Aalten, Pauline van Berckel, Bart N. M. Scheltens, Philip |
author_facet | Zwan, Marissa D. Bouwman, Femke H. Konijnenberg, Elles van der Flier, Wiesje M. Lammertsma, Adriaan A. Verhey, Frans R. J. Aalten, Pauline van Berckel, Bart N. M. Scheltens, Philip |
author_sort | Zwan, Marissa D. |
collection | PubMed |
description | BACKGROUND: Early-onset dementia patients often present with atypical clinical symptoms, hampering an accurate clinical diagnosis. The purpose of the present study was to assess the diagnostic impact of the amyloid-positron emission tomography (PET) imaging agent [(18)F]flutemetamol in early-onset dementia patients, in terms of change in (confidence in) diagnosis and patient management plan. METHODS: This prospective bi-center study included 211 patients suspected of early-onset dementia who visited a tertiary memory clinic. Patients were eligible with Mini Mental State Examination ≥ 18 and age at diagnosis ≤ 70 years and in whom the diagnostic confidence was <90% after routine diagnostic work-up. All patients underwent [(18)F]flutemetamol PET, which was interpreted as amyloid-negative or amyloid-positive based on visual rating. Before and after disclosing the PET results, we assessed the diagnostic confidence (using a visual analog scale of 0–100%) and clinical diagnosis. The impact of [(18)F]flutemetamol PET on the patient management plan was also evaluated. RESULTS: [(18)F]flutemetamol PET scans were positive in 133 out of 211 (63%) patients, of whom 110 out of 144 (76%) patients had a pre-PET Alzheimer’s disease (AD) diagnosis and 23 out of 67 (34%) patients had a non-AD diagnosis. After disclosure of PET results, 41/211 (19%) diagnoses changed. Overall, diagnostic confidence increased from 69 ± 12% to 88 ± 15% after disclosing PET results (P < 0.001; in 87% of patients). In 79 (37%) patients, PET results led to a change in patient management and predominantly the initiation of AD medication when PET showed evidence for amyloid pathology. CONCLUSIONS: [(18)F]flutemetamol PET changed clinical diagnosis, increased overall diagnostic confidence, and altered the patient management plan. Our results suggest that amyloid PET may have added value over the standardized diagnostic work-up in early-onset dementia patients with uncertain clinical diagnosis. This study provides evidence for the recommendations put forward in the appropriate use criteria for amyloid PET in clinical practice. TRIAL REGISTRATION: Nederlands Trial Register NTR3743. Registered 7 December 2012. |
format | Online Article Text |
id | pubmed-5240413 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-52404132017-01-23 Diagnostic impact of [(18)F]flutemetamol PET in early-onset dementia Zwan, Marissa D. Bouwman, Femke H. Konijnenberg, Elles van der Flier, Wiesje M. Lammertsma, Adriaan A. Verhey, Frans R. J. Aalten, Pauline van Berckel, Bart N. M. Scheltens, Philip Alzheimers Res Ther Research BACKGROUND: Early-onset dementia patients often present with atypical clinical symptoms, hampering an accurate clinical diagnosis. The purpose of the present study was to assess the diagnostic impact of the amyloid-positron emission tomography (PET) imaging agent [(18)F]flutemetamol in early-onset dementia patients, in terms of change in (confidence in) diagnosis and patient management plan. METHODS: This prospective bi-center study included 211 patients suspected of early-onset dementia who visited a tertiary memory clinic. Patients were eligible with Mini Mental State Examination ≥ 18 and age at diagnosis ≤ 70 years and in whom the diagnostic confidence was <90% after routine diagnostic work-up. All patients underwent [(18)F]flutemetamol PET, which was interpreted as amyloid-negative or amyloid-positive based on visual rating. Before and after disclosing the PET results, we assessed the diagnostic confidence (using a visual analog scale of 0–100%) and clinical diagnosis. The impact of [(18)F]flutemetamol PET on the patient management plan was also evaluated. RESULTS: [(18)F]flutemetamol PET scans were positive in 133 out of 211 (63%) patients, of whom 110 out of 144 (76%) patients had a pre-PET Alzheimer’s disease (AD) diagnosis and 23 out of 67 (34%) patients had a non-AD diagnosis. After disclosure of PET results, 41/211 (19%) diagnoses changed. Overall, diagnostic confidence increased from 69 ± 12% to 88 ± 15% after disclosing PET results (P < 0.001; in 87% of patients). In 79 (37%) patients, PET results led to a change in patient management and predominantly the initiation of AD medication when PET showed evidence for amyloid pathology. CONCLUSIONS: [(18)F]flutemetamol PET changed clinical diagnosis, increased overall diagnostic confidence, and altered the patient management plan. Our results suggest that amyloid PET may have added value over the standardized diagnostic work-up in early-onset dementia patients with uncertain clinical diagnosis. This study provides evidence for the recommendations put forward in the appropriate use criteria for amyloid PET in clinical practice. TRIAL REGISTRATION: Nederlands Trial Register NTR3743. Registered 7 December 2012. BioMed Central 2017-01-17 /pmc/articles/PMC5240413/ /pubmed/28093088 http://dx.doi.org/10.1186/s13195-016-0228-4 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Zwan, Marissa D. Bouwman, Femke H. Konijnenberg, Elles van der Flier, Wiesje M. Lammertsma, Adriaan A. Verhey, Frans R. J. Aalten, Pauline van Berckel, Bart N. M. Scheltens, Philip Diagnostic impact of [(18)F]flutemetamol PET in early-onset dementia |
title | Diagnostic impact of [(18)F]flutemetamol PET in early-onset dementia |
title_full | Diagnostic impact of [(18)F]flutemetamol PET in early-onset dementia |
title_fullStr | Diagnostic impact of [(18)F]flutemetamol PET in early-onset dementia |
title_full_unstemmed | Diagnostic impact of [(18)F]flutemetamol PET in early-onset dementia |
title_short | Diagnostic impact of [(18)F]flutemetamol PET in early-onset dementia |
title_sort | diagnostic impact of [(18)f]flutemetamol pet in early-onset dementia |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5240413/ https://www.ncbi.nlm.nih.gov/pubmed/28093088 http://dx.doi.org/10.1186/s13195-016-0228-4 |
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