Friday, April 11, 2014

Impact Of Amyloid Beta Imaging On Diagnosis And Clinical Management Of Hypothetical Patients With Mild Cognitive Impairment Or Dementia. (P3.210)

Impact Of Amyloid Beta Imaging On Diagnosis And Clinical Management Of Hypothetical Patients With Mild Cognitive Impairment Or Dementia. (P3.210)
Neurology recent issues

OBJECTIVE: To assess the potential impact of amyloid beta imaging information on diagnostic judgments and management recommendations by clinicians evaluating patients presenting with a cognitive complaint.BACKGROUND: Positron emission tomography (PET) can detect beta-amyloid plaque accumulations, a hallmark of Alzheimer's disease (AD). FDA has approved this technology based on its accuracy relative to post-mortem assessment. This study further assesses amyloid PET imaging by measuring its potential to influence diagnostic judgments and patient management recommendations.DESIGN/METHODS: We surveyed 315 practicing neurologists (N = 159), geriatricians (N = 22), and psychiatrists (N = 134), presenting each with a vignette describing one of three randomly selected hypothetical patients with a cognitive complaint (unexplained MCI, possible AD, or atypically young-onset dementia). Each vignette also included (at random) amyloid PET imaging findings consistent with AD ("positive finding"), findings inconsistent with AD ("negative finding"), or no mention of amyloid PET imaging findings. We then asked respondents about diagnosis and patient management. We tested associations using multiple logistic regression (two possible outcomes) or ordered logistic regression (ordinal outcomes), controlling for multiple factors simultaneously.RESULTS: DIAGNOSIS - Compared to respondents shown no amyloid PET imaging information, respondents given positive findings were 5.9 times more likely to include AD as a sole or contributing factor; respondents shown negative findings were 10 times less likely to include AD in their diagnosis. Positive amyloid PET imaging findings increased diagnostic confidence, while negative findings had no effect. MANAGEMENT - Relative to no amyloid PET imaging, findings did not in general alter care, although for young-onset dementia patients, negative amyloid PET imaging findings made respondents more likely to say they would refer patients to other clinicians.CONCLUSIONS: Because this large-scale survey indicates amyloid PET imaging influences dementia diagnosis, this technology can potentially help clinicians make more appropriate care recommendations. However, additional research is required to understand the extent of the impact.Study Supported by: GE Healthcare

Disclosure: Dr. Cohen has received research support from GE Healthcare. Dr. Zhong has received research support from GE Healthcare. Dr. Karlawish has received personal compensation in an editorial capacity for the Journal of the American Geriatrics Society. Dr. Karlawish has received license fee payments.



Original Article: http://www.neurology.org/cgi/content/short/82/10_Supplement/P3.210?rss=1

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