Clinical impact of [18F]flutemetamol PET among memory clinic patients with an unclear diagnosis

Antoine Leuzy, Irina Savitcheva, Konstantinos Chiotis, Johan Lilja, Pia Andersen, Nenad Bogdanovic, Vesna Jelic, Agneta Nordberg, Antoine Leuzy, Irina Savitcheva, Konstantinos Chiotis, Johan Lilja, Pia Andersen, Nenad Bogdanovic, Vesna Jelic, Agneta Nordberg

Abstract

Purpose: To investigate the impact of amyloid PET with [18F]flutemetamol on diagnosis and treatment management in a cohort of patients attending a tertiary memory clinic in whom, despite extensive cognitive assessment including neuropsychological testing, structural imaging, CSF biomarker analysis and in some cases [18F]FDG PET, the diagnosis remained unclear.

Methods: The study population consisted of 207 patients with a clinical diagnosis prior to [18F]flutemetamol PET including mild cognitive impairment (MCI; n = 131), Alzheimer's disease (AD; n = 41), non-AD (n = 10), dementia not otherwise specified (dementia NOS; n = 20) and subjective cognitive decline (SCD; n = 5).

Results: Amyloid positivity was found in 53% of MCI, 68% of AD, 20% of non-AD, 20% of dementia NOS, and 60% of SCD patients. [18F]Flutemetamol PET led, overall, to a change in diagnosis in 92 of the 207 patients (44%). A high percentage of patients with a change in diagnosis was observed in the MCI group (n = 67, 51%) and in the dementia NOS group (n = 11; 55%), followed by the non-AD and AD (30% and 20%, respectively). A significant increase in cholinesterase inhibitor treatment was observed after [18F]flutemetamol PET (+218%, 34 patients before and 108 patients after).

Conclusion: The present study lends support to the clinical value of amyloid PET in patients with an uncertain diagnosis in the tertiary memory clinic setting.

Keywords: Alzheimer’s disease; Amyloid PET; Cholinesterase inhibitors; Diagnostic change; [18F]Flutemetamol.

Conflict of interest statement

Conflicts of interest

J.L. is an employee of Hermes Medical Solutions, Stockholm, Sweden. All other authors declare no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Figures

Fig. 1
Fig. 1
CT/MRI-based ratings of atrophy and white matter changes and [18F]FDG PET metabolic patterns shown as the distributions of medial temporal atrophy (a), global atrophy (b), white matter changes (c) and metabolic patterns (d) based on the diagnoses made prior to [18F]flutemetamol PET (the number at the top of each column indicates the number of patients)
Fig. 2
Fig. 2
Relationships between CSF biomarkers and isocortical composite [18F]flutemetamol SUVR. The vertical lines mark the cut-off value of 0.60 for isocortical composite [18F]flutemetamol SUVR; the horizontal linesmark the cut-off values for Aβ1-42 (a <550 pg/mL), p-tau  (b >80 pg/mL) and t-tau (c >400 pg/mL); the dashed lines indicate borderline zones (within 5% of the cut-off values); and the grey and white quadrants indicate concordance and discordance between biomarkers, respectively
Fig. 3
Fig. 3
Visual [18F]flutemetamol ratings in the various diagnostic groups before (a) and after (b) [18F]flutemetamol PET (the number at the top of each column indicates the number of patients). Red [18F]flutemetamol-positive, blue [18F]flutemetamol-negative

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