Added value of ¹⁸F‐florbetaben amyloid PET in the diagnostic workup of most complex patients with dementia in France: A naturalistic study

Abstract

High-level improvement of diagnostic certainty and management is provided by selective and hierarchical implementation of florbetaben PET into current standard practices for the most complex dementia cases.

Amyloid imaging for differential diagnosis of dementia: incremental value compared to clinical diagnosis and [18F]FDG PET

“…The additional knowledge of the patients’ amyloid status led to a change in the clinical and [ 18 F]FDG PET diagnoses in about every fourth and fifth patient, respectively. As demonstrated in previous studies, this would be expected to directly affect patient management [5, 7, 9–11, 14]. The correctness of changes in diagnosis after disclosure of the amyloid imaging results is supported by a strong convergence of the two independent diagnostic paths, clinical diagnosis and [ 18 F]FDG PET (from 62% to 86% agreement) on the one hand and a strong increase in their diagnostic accuracy compared with the final consensus diagnosis after an extended follow-up (from 71% to 89% and 76% to 94%, respectively) on the other.…”

“…As would be expected, changes in diagnosis were accompanied by significant increases in diagnostic confidence [5–11, 14] and changes in patient management in most studies, albeit to a variable extent (about 40–90%) depending on the items under consideration (e.g. medication, diagnostic tests, referrals, counselling) [5, 7, 10, 11, 14]. In this regard, a particularly interesting study is the recent multicentre, randomized controlled study by Pontecorvo et al [9].…”

“…In turn, a slightly larger fraction of patients (29% to 57%) with a baseline diagnosis of cognitive impairment not due to AD (non-AD) were amyloid-positive [4–10]. This translates into a change in diagnoses in about 20–30% (range 9–67%) of all patients [4–16], in which the lower and upper ranges of observed frequencies of change were found in patients with early onset or from research populations (few uncertain diagnoses) [4, 16] and in patients with late onset or a particularly challenging diagnosis [4, 14–16], respectively.…”

“…[17]), it is comprehensible that a negative amyloid scan was more often associated with a change in diagnosis than a positive amyloid scan in some but not all studies [5, 12–14]. As would be expected, changes in diagnosis were accompanied by significant increases in diagnostic confidence [5–11, 14] and changes in patient management in most studies, albeit to a variable extent (about 40–90%) depending on the items under consideration (e.g. medication, diagnostic tests, referrals, counselling) [5, 7, 10, 11, 14].…”

Neurofilament light chain in serum for the diagnosis of amyotrophic lateral sclerosis

“…This would be particularly valuable in cases where diagnostic doubt exists: although for the experienced ALS neurologist ALS diagnosis is in most cases straightforward, the diagnostic process is still problematic in a minority of patients,38 also because of the clinical heterogeneity of the disease 39 40. It would be highly informative to investigate the value of NF measurement in a specific cohort of patients with a challenging diagnosis, especially in order to determine to what extent the result of this test would influence or change the diagnosis, analogous to studies performed on amyloid positron emission tomography examination in cases of dementia with conflicting results on investigations for AD (eg, non-conclusive CSF results) 41. Furthermore, in a public health and organisation perspective, it should be considered that–notwithstanding the progressive homologation of healthcare measures, especially through adoption of common international guidelines–measurement of serum NFL could be performed with slightly different criteria and aims in the context of different healthcare systems and organisational realities.…”