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amyloid positron emission tomography (amyloid PET)

Indications: - evaluation of Alzheimer's disease (AD) a) sensitivity > specificity b) bilateral parietal hypometabolism Procedure: - amyloid PET using fluoride-18 florbetaben Pathology: - disrupted circadian rhythms in cognitively normal adults linked to higher subsequent amyloid-beta PET burden [7] - link stronger in APOE4 carriers Genetics: - parental memory impairment associated with amyloid burden in cognitively unimpaired older adults [8] - maternal memory impairment at any age - paternal memory impairment at early age Clinical significance: - both amyloid-positive & amyloid-negative results associated with changes in diagnosis & treatment [1] - in both patients with dementia & those with mild cognitive impairment [3] - early amyloid PET improves confidence in diagnosis [4] - amyloid PET using [18F]-florbetapir not cost-effective [2] - no difference in change in healthcare utilization between patients with PET scans showing elevated vs non-elevated beta-amyloid [6] Notes: - there is also a TAU-PET for AD - CMS is proposing to end restrictions on how many amyloid PET scans Alzheimer's disease patients can receive [5]

Specific

adenosine positron emission tomography (adenosine PET)

General

positron emission tomography (PET, PET scan)

References

  1. George J, Solomon HA, Caputo D Amyloid PET Changes Diagnosis, Treatment. Dutch study may boost prospects for insurance, Medicare coverage. MedPage Today. June 11, 2018 https://www.medpagetoday.com/neurology/alzheimersdisease/73412 - de Wilde A, van der Flier WM, Pelkmans W et al Association of Amyloid Positron Emission Tomography With Changes in Diagnosis and Patient Treatment in an Unselected Memory Clinic Cohort: The ABIDE Project. JAMA Neurol. 2018 Jun 11. PMID: 29889941 - Salloway S Improving Evaluation of Patients With Cognitive Impairment With Amyloid Positron Emission Tomography. JAMA Neurol. 2018 Jun 11. PMID: 29889928
  2. Boccardi M, Altomare D, Ferrari C et al. Assessment of the incremental diagnostic value of florbetapir F 18 imaging in patients with cognitive impairment: The Incremental Diagnostic Value of Amyloid PET With [18F]- Florbetapir (INDIA-FBP) study. JAMA Neurol 2016 Oct 31; PMID: 27802513 http://jamanetwork.com/journals/jamaneurology/article-abstract/2578330
  3. 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 PMID: 30938796 https://jamanetwork.com/journals/jama/fullarticle/2729371 - Jack CR Jr, Petersen RC. Amyloid PET and Changes in Clinical Management for Patients With Cognitive Impairment. JAMA. 2019;321(13):1258-1260 PMID: 30938781 https://jamanetwork.com/journals/jama/fullarticle/2729351
  4. Altomare D et al. Clinical effect of early vs late amyloid positron emission tomography in memory clinic patients: The AMYPAD-DPMS randomized clinical trial. JAMA Neurol 2023 Jun 1; 80:548. PMID: 37155177 PMCID: PMC10167601 Free PMC article https://jamanetwork.com/journals/jamaneurology/fullarticle/2804755
  5. CMS.gov. July 2023 Beta Amyloid Positron Emission Tomography in Dementia and Neurodegenerative Disease. https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=Y&NCAId=308
  6. Jutkowitz E, Shewmaker P, Ford CB et al Association between results of an amyloid PET scan and healthcare utilization in individuals with cognitive impairment. J Am Geriatr Soc. 2024 Mar;72(3):707-717 PMID: 38069618 https://agsjournals.onlinelibrary.wiley.com/doi/abs/10.1111/jgs.18696
  7. George J Alzheimer's Amyloid Tied to Circadian Disruption Earlier in Life. Sleep fragmentation may be an Alzheimer's risk factor, data suggest. MedPage Today June 24, 2024 . https://www.medpagetoday.com/neurology/alzheimersdisease/110799 - Nguyen Ho PT, Hoepel SJW, Rodriguez-Ayllon M et al Sleep, 24-Hour Activity Rhythms, and Subsequent Amyloid-beta Pathology. JAMA Neurol. Published online June 24, 2024. PMID: 38913396 https://jamanetwork.com/journals/jamaneurology/fullarticle/2820395
  8. Seto M, Hohman TJ, Mormino EC et al. Parental history of memory impairment and beta-amyloid in cognitively unimpaired older adults. JAMA Neurol 2024 Jun 17; [e-pub]. PMID: 38884955 https://jamanetwork.com/journals/jamaneurology/fullarticle/2820195