What is your doctor doing to rule out or confirm dementia?
ANYTHING AT ALL?
You need to know. Lots of words used here so you can't even tell how accurate it is.
http://www.alzheimersweekly.com/2017/02/f18-scans-diagnose-dementia-better.html
At $3,000 per scan, are F18 Scans worth it? They let doctors see plaque
in the brain, the main suspect behind Alzheimer's. They show doctors if,
where and how much plaque there is. They can sharpen an Alzheimer's
diagnosis or rule it out completely. Learn how F18 Scans improve care
and diagnosis.
INDIANAPOLIS -- Eli Lilly released important data showing that F18
beta-amyloid imaging was associated with better diagnosis and management
of patients with dementia.
There are over 100 tpyes of dementia. Some are curable, some demand
different treatments than others. The differences in treatment can be
critical.
The most common type of dementia is Alzheimer's disease. It is so common
that it is common for doctors to diagnose a patient with Alzheimer's
when they really have a different type of dementia. This can lead to
ineffective or even dangerous treatments. Furthermore, even when a
person has Alzheimer's, it is challenging to treat it. Doctors usually
base the medications they prescribe, as well as recommended treatments,
on a somewhat subjective judgement call referred to as a "clinical
diagnosis".
With new F18 scanning technologies, doctors can actually "see" how much
Alzheimer's plaque is in a person's brain, if any. They now have an
objective tool to help them dramatically sharpen their diagnosis.
To see an invterview of a patient who benefitted from an F18 Scan after he was diagnosed with dementia, watch the video,
"
F18 Alzheimer's Scan Delivers Better Prescriptions & Fewer Tests".
In this latest study from Ely Lilly, change in management was observed
in both patients who met and did not meet the Appropriate Use Criteria
(AUC), which were developed by the Society of Nuclear Medicine and
Molecular Imaging and the Alzheimer's Association to provide guidance on
which patients are most appropriate for imaging and how best to use the
results. These data were presented at the Alzheimer's Association
International Conference (AAIC) by Andrew Siderowf, M.D., MSCE, medical
director, Avid Radiopharmaceuticals, a subsidiary of Lilly.
"This study included patients in which there was diagnostic uncertainty
by the treating physician and found that changes in diagnosis and
management of Alzheimer's disease did not vary between patients
depending on whether they met the Appropriate Use Criteria or not. In
addition, analysis of beta-amyloid scans conducted post-diagnosis
indicated that many patients being treated with medications may have
potentially been misdiagnosed and inappropriately treated," said Dr.
Siderowf. "While we support the development of the Appropriate Use
Criteria, one of the clearest insights resulting from these data is that
we need to continue to fine tune our understanding of the appropriate
use of these tools and their utility for patients facing a diagnosis of
Alzheimer's disease."
The objective of the study was to evaluate which patients are most
likely to receive different care if they had an amyloid PET scan as part
of their diagnostic work-up. In particular, the study evaluated if
patients who met the working definition of the AUC would be more
affected than those who did not. The AUC guidelines propose that
patients who are being evaluated for dementia with atypical
presentations, younger patients, and patients with unexplained mild
cognitive impairment, are most appropriate for amyloid PET imaging. For
the patient to be included in the study, Alzheimer's disease had to be
under consideration and the treating physician had to have uncertainty
regarding the diagnosis.
Results showed that 59 percent of subjects met the working
definition of AUC. Forty-seven percent of the AUC-like cases were
amyloid positive compared to 62 percent of non-AUC cases. Diagnosis
changed after PET scan for 58 percent of AUC cases versus 45 percent of
non-AUC cases (p=0.10). The proportion of patients with change in
management plan was high for both AUC (88 percent) and non-AUC (77
percent) cases. In particular, the use of Alzheimer's disease
medications including cholinesterase inhibitors, or memantine, declined
after a negative florbetapir F 18 scan by 20 percent (from 26/54 to
15/54 cases; p=0.002) in AUC cases and by 33 percent (from 17/27 to 8/27
cases; p=0.004) in non-AUC cases. Diagnoses for non-AUC cases in which
Alzheimer's disease medications were withdrawn after a negative scan
included prodromal Alzheimer's disease/mild cognitive impairment due to
Alzheimer's disease (n=8), or mild cognitive impairment of uncertain
etiology (n=1). This study found that patients with an uncertain
diagnosis, but who are not otherwise explicitly captured by AUC, may be
reasonable candidates for amyloid imaging.
"Alzheimer's disease is one of many possible causes of cognitive
impairment, which can make diagnosis challenging. In fact, it is
estimated that up to one in five patients clinically diagnosed with
probable Alzheimer's disease during life do not exhibit Alzheimer's
disease pathology upon autopsy[1],[2]," said Dr. Siderowf. "These
results reinforce how knowledge of the presence or absence of amyloid
pathology can substantially affect both diagnosis and management in
these patients being evaluated for Alzheimer's disease or other possible
causes of cognitive decline."
MORE INFORMATION:
Study Methods
The impact of amyloid PET on actual patient care was examined in a previous study.[3]
In the prior study, performed at 19 clinical sites, treating
physicians provided a provisional diagnosis and management plan prior to
receiving results of amyloid PET imaging with florbetapir F 18.
Participants' medical records for the three months immediately after
imaging were abstracted to capture their actual diagnosis and
management. For the current study, participants were classified as
meeting an operational definition of AUC-like or not, based on pre-scan
diagnosis and demographic features.
About Florbetapir F 18 Injection[6]
Florbetapir F 18 is indicated for Positron Emission
Tomography (PET) imaging of the brain to estimate beta-amyloid neuritic
plaque density in adult patients with cognitive impairment who are being
evaluated for Alzheimer's Disease (AD) and other causes of cognitive
decline. A negative florbetapir F 18 scan indicates sparse to no
neuritic plaques and is inconsistent with a neuropathological diagnosis
of AD at the time of image acquisition; a negative scan result reduces
the likelihood that a patient's cognitive impairment is due to AD. A
positive florbetapir F 18 scan indicates moderate to frequent amyloid
neuritic plaques; neuropathological examination has shown this amount of
amyloid neuritic plaque is present in patients with AD, but may also be
present in patients with other types of neurologic conditions as well
as older people with normal cognition. Florbetapir F 18 is an adjunct to
other diagnostic evaluations.
Limitations of Use:
- A positive florbetapir F 18 scan does not establish a diagnosis of AD or other cognitive disorder
- Safety and effectiveness of florbetapir F 18 have not been established for:
- Predicting development of dementia or other neurologic condition
- Monitoring responses to therapies
WARNINGS AND PRECAUTIONS
Risk for Image Misinterpretation and Other Errors
- Errors may occur in the florbetapir F 18 estimation of brain neuritic plaque density during image interpretation
- Image interpretation should be performed independently of the
patient's clinical information. The use of clinical information in the
interpretation of florbetapir F 18 images has not been evaluated and may
lead to errors. Other errors may be due to extensive brain atrophy that
limits the ability to distinguish gray and white matter on the
florbetapir F 18 scan as well as motion artifacts that distort the image
- Florbetapir F 18 scan results are indicative of the brain neuritic
amyloid plaque content only at the time of image acquisition and a
negative scan result does not preclude the development of brain amyloid
in the future
Radiation Risk
- Florbetapir F 18, similar to other radiopharmaceuticals,
contributes to a patient's overall long‐term cumulative radiation
exposure. Long-term cumulative radiation exposure is associated with an
increased risk of cancer. Ensure safe handling to protect patients and
health care workers from unintentional radiation exposure
MOST COMMON ADVERSE REACTIONS
- The most common adverse reactions reported in clinical trials were
headache (1.8%), musculoskeletal pain (0.7%), blood pressure increased
(0.7%), nausea (0.7%), fatigue (0.5%), and injection site reaction
(0.5%)
For more information about florbetapir F 18, please see the Prescribing Information athttp://pi.lilly.com/us/amyvid‐uspi.pdf.
About Eli Lilly and Company
Lilly is a global healthcare leader that unites caring with
discovery to make life better for people around the world. We were
founded more than a century ago by a man committed to creating
high-quality medicines that meet real needs, and today we remain true to
that mission in all our work. Across the globe, Lilly employees work to
discover and bring life-changing medicines to those who need them,
improve the understanding and management of disease, and give back to
communities through philanthropy and volunteerism. To learn more about
Lilly, please visit us at
www.lilly.com and
http://newsroom.lilly.com/social-channels.
Amyvid™ is a trademark of Eli Lilly and Company.
[1] Petrovitch H, White LR, Ross GW, et al. Accuracy of clinical
criteria for AD in the Honolulu-Asia Aging Study, a population-based
study. Neurology. 2001;57(2):226–234.
[2] Lim A, Tsuang D, Kukull W, et al. Clinico-neuropathological
correlation of Alzheimer's disease in a community-based case series. J
Am Geriatr Soc. 1999;47(5):564–569.
[3] Grundman M, Pontecorvo MJ, Salloway SP, et al. Potential impact of
amyloid imaging on diagnosis and intended management in patients with
progressive cognitive decline.
Alzheimer Dis Assoc Disord. 2013 Jan;27(1):4-15.
[4] Alzheimer's Association. 2014 Alzheimer's Disease Facts and Figures.
http://www.alz.org/downloads/facts_figures_2014.pdf. Accessed on June 4, 2014.
[5] Alzheimer's Disease International. Policy Brief for Heads of Government: The Global Impact of Dementia 2013 - 2050.
http://www.alz.co.uk/research/GlobalImpactDementia2013.pdf. Published December 2013. Accessed onJune 4, 2014.
[6] Amyvid [package insert]. Indianapolis, IN: Lilly USA, LLC; 2012.
