A first-of-its-kind national study has found that a form of brain imaging that detects Alzheimer’s-related “plaques” significantly influenced clinical management of patients with mild cognitive impairment and dementia, Medical Xpress reports.
The study revealed that providing clinicians with the results of positron emission tomography (PET) scans that identify amyloid plaques in the brain changed medical management—including the use of medications and counseling—in nearly two-thirds of cases, more than double what researchers predicted in advance of the study. The technique, known as “amyloid PET imaging,” also altered the diagnosis of the cause of cognitive impairment in more than one in three study participants.
The multicenter study of more than 11,000 Medicare beneficiaries, published April 2, 2019 in the Journal of the American Medical Association (JAMA), was managed by the American College of Radiology and led by scientists at the Alzheimer’s Association, UC San Francisco, Brown University School of Public Health, Virginia Commonwealth University School of Public Health, Washington University School of Medicine in St. Louis, UC Davis School of Medicine, and the Kaiser Permanente Division of Research.
“We are impressed by the magnitude of these results, which make it clear that amyloid PET imaging can have a major impact on how we diagnose and care for patients with Alzheimer’s disease and other forms of cognitive decline,” said study lead author and principal investigator Gil Rabinovici, MD, Distinguished Professor of Neurology at the UCSF Memory and Aging Center and member of the UCSF Weill Institute for Neurosciences.
“These results present highly credible, large-scale evidence that amyloid PET imaging can be a powerful tool to improve the accuracy of Alzheimer’s diagnosis and lead to better medical management, especially in difficult-to-diagnose cases,” added Maria C. Carrillo, Ph.D., Alzheimer’s Association chief science officer and a co-author of the study. “It is important that amyloid PET imaging be more broadly accessible to those who need it.”
Alzheimer’s disease is characterized by the accumulation of both amyloid protein plaques and tau protein “tangles” in the brain, the presence of which are required for a definitive diagnosis. Until recently, amyloid plaques could only be detected by postmortem analysis of autopsied brain tissue. With the advent of amyloid PET—which involves injecting patients with “tracer” molecules that stick to amyloid plaques and can be used to visualize their location in the brain—it became possible to detect plaques with a brain scan and therefore more accurately diagnose people living with the disease.
Though there is no cure for Alzheimer’s disease, early diagnoses enable physicians to prescribe appropriate symptom-management therapies, counsel families on important safety and care-planning issues and direct people to clinical trials for promising new drugs. It also allows people with the disease and their families to plan for the future, including legal and financial issues, and accessing resources and support programs. PET imaging results that reveal no signs of amyloid buildup in the brain rule out Alzheimer’s disease as the cause of memory loss, which can prompt an evaluation for alternative and sometimes reversible causes, such as medication side effects, sleep or mood disorders and other medical conditions.
However, despite FDA approval of amyloid PET tracers, use of amyloid PET imaging to assist with the accurate diagnosis of the cause of someone’s dementia is currently not covered by Medicare or health insurance plans, making it unavailable to most people.
Launched in 2016, the four-year Imaging Dementia—Evidence for Amyloid Scanning (IDEAS) study was developed by a team of scientists convened by the Alzheimer’s Association to determine whether learning the results amyloid PET imaging would change medical management and health outcomes of people with memory loss and cognitive decline. IDEAS recruited nearly 1,000 dementia specialists at 595 sites in the U.S. and enrolled more than 16,000 Medicare beneficiaries with mild cognitive impairment or dementia of uncertain cause. Under their Coverage with Evidence Development policy, the Centers for Medicare & Medicaid Services (CMS) reimbursed amyloid PET scans conducted at 343 facilities and interpreted by more than 700 imaging specialists as part of this clinical study.