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Clinical Trial
. 2017 Jan 17;9(1):2.
doi: 10.1186/s13195-016-0228-4.

Diagnostic impact of [18F]flutemetamol PET in early-onset dementia

Marissa D Zwan  1   2 , Femke H Bouwman  3 , Elles Konijnenberg  3 , Wiesje M van der Flier  3   4 , Adriaan A Lammertsma  5 , Frans R J Verhey  6 , Pauline Aalten  6 , Bart N M van Berckel  5 , Philip Scheltens  3
Affiliations
Clinical Trial

Diagnostic impact of [18F]flutemetamol PET in early-onset dementia

Marissa D Zwan et al. Alzheimers Res Ther. .

Abstract

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 [18F]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 [18F]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 [18F]flutemetamol PET on the patient management plan was also evaluated.

Results: [18F]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: [18F]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.

Keywords: Alzheimer’s disease; Amyloid; Clinical practice; Dementia; Diagnostic impact; Imaging; Positron emission tomography.

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Figures

Fig. 1
Fig. 1
Diagnostic confidence prior to PET related to a changed diagnosis and b changed patient management plan. AD Alzheimer’s disease dementia, non-AD non-AD diagnosis, PET positron emission tomography
See this image and copyright information in PMC

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