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Apostolova LG, Haider JM, Goukasian N, Rabinovici GD, Chételat G, Ringman JM, Kremen S, Grill JD, Restrepo L, Mendez MF, Silverman DH. Critical review of the Appropriate Use Criteria for amyloid imaging: Effect on diagnosis and patient care. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2016; 5:15-22. [PMID: 28054024 PMCID: PMC5198877 DOI: 10.1016/j.dadm.2016.12.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Introduction The utility of the Appropriate Use Criteria (AUC) for amyloid imaging is not established. Methods Fifty-three cognitively impaired patients with clinical F18-florbetapir imaging were classified as early and late onset, as well as AUC-consistent or AUC-inconsistent. Chi-square statistics and t test were used to compare demographic characteristics and clinical outcomes as appropriate. Results Early-onset patients were more likely to be amyloid positive. Change in diagnosis was more frequent in late-onset cases. Change in therapy was more common in early-onset cases. AUC-consistent and AUC-inconsistent cases had comparable rates of amyloid positivity. We saw no difference in the rate of treatment changes in the AUC-consistent group as opposed to the AUC-inconsistent group. Discussion The primary role of amyloid imaging in the early-onset group was to confirm the clinically suspected etiology, and in the late-onset group in detecting amyloid-negative cases. The rate of therapeutic changes was significantly greater in the early-onset cases. Both AUC-consistent and AUC-inconsistent patients benefit from amyloid imaging. The greatest benefit in early-onset patients is confirming the suspected etiology. The greatest benefit in late-onset patients is detecting amyloid-negative cases.
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Affiliation(s)
- Liana G Apostolova
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Radiological Sciences, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Janelle M Haider
- Department of Neurology, Cedar-Sinai Medical Center, Los Angeles, CA, USA
| | - Naira Goukasian
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Gil D Rabinovici
- Memory & Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Gael Chételat
- Inserm, EPHE, Université de Caen Basse-Normandie, Unité de Recherche 1077, Caen, France
| | - John M Ringman
- Department of Neurology, Keck School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
| | - Sarah Kremen
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Joshua D Grill
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA, USA
| | - Lucas Restrepo
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Mario F Mendez
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA; Department of Psychiatry, University of California Los Angeles, Los Angeles, CA, USA
| | - Daniel H Silverman
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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