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Cited by 118Dementia and Cognitive Impairment ResearchAlzheimer's disease research and treatmentsMedical Imaging Techniques and Applications

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

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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. +1 more·2017·Alzheimer's Research & Therapy
DOI 10.1186/s13195-016-0228-4PMC PMC5240413
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Abstract

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. 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. [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. [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. Nederlands Trial Register NTR3743 . Registered 7 December 2012.

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  • A similar proportion of individuals clinically diagnosed as AD dementia have normal amyloid PET or CSF Aβ42 studies.

    “and a similar proportion has normal amyloid PET or CSF Aβ42 studies [53–62].”

    From NIA‐AA Research Framework: Toward a biological definition of Alzheimer's disease (2018) · cites this paper as [58]

    The Results (Clinical diagnosis, Table 2) show that 34 of 144 patients clinically diagnosed with AD before PET had a negative amyloid PET scan. This supports the PET portion, but the study concerns a selected early-onset dementia cohort and does not report a comparable proportion with normal CSF Aβ42; the Discussion says CSF results were not used in making the clinical diagnosis. (LLM, conf=0.85)

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Authors
Zwan, M. D., Bouwman, F. H., Konijnenberg, E., van der Flier, W. M., Lammertsma, A. A., Verhey, F. R. J., Aalten, P., van Berckel, B. N. M., & Scheltens, P.
Affiliations
  • Amsterdam Neuroscience (NL)
  • Maastricht University (NL)
Corresponding author
Zwan, Marissa D.
ORCID
Venue
Alzheimer's Research & Therapy
Publisher
Springer Science and Business Media LLC
Published
2017-01-17
Volume
9
Issue
1
Pages
2-2
ISSN
1758-9193 (ISSN-L)
DOI
10.1186/s13195-016-0228-4
PMC
PMC5240413
OpenAlex
W2568095284
Cited by
118
References
5
Citations by year
2026: 1 · 2025: 7 · 2024: 11 · 2023: 8 · 2022: 11 · 2021: 14 · 2020: 15 · 2019: 20 · 2018: 19 · 2017: 12
FWCI
14.83
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Alzheimer s Research & Therapy (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (publishedVersion, other-oa)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
  • Research Publications (Maastricht University) (submittedVersion, cc-by)
  • Research Publications (Maastricht University) (submittedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Funders
  • Dutch Alzheimer's Society (WE.15-2014-01)
  • GE Healthcare (n.a.)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Medical Imaging Techniques and Applications
Keywords
18F-flutemetamol, amyloid PET, early-onset dementia, Alzheimer's disease, diagnostic confidence, amyloid pathology, diagnosis, clinical management, appropriate use criteria
MeSH terms
Aged, Aniline Compounds, Brain, Dementia, Female, Fluorine Radioisotopes, Humans, Male, Middle Aged, Prospective Studies, Age of Onset, Radiopharmaceuticals, Positron-Emission Tomography, Benzothiazoles

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