1. Use of Amyloid PET Scan in Early Diagnosis of Alzheimer’s Disease in a Secondary Care Memory Clinic
Niki Schoonenboom, MD PhD1, Mohammed Akarriou, MD2; Kees Kalisvaart, MD, PhD3
1 Department of Neurology, 2 Department of Nuclear Medicine, 3 Department of Geriatrics. Spaarne Gasthuis, Haarlem, the Netherlands
AUC criteria MCI (1) en Dementia (2)
Background: Biomarkers for Alzheimer’s disease (AD) are of aid in supporting the correct diagnosis in an early stage. In the Netherlands there is quite some experience with the CSF biomarkers amyloid beta 42 and (phosphorylated) tau next to MRI. However, the use of FDG and especially amyloid PET imaging in secondary memory clinics needs to be established.
Characteristics of patients
(1)
Obj cog
Alters management
Persist/progressive MCI
Young
(< 70)
Amyloid
SCI no
yes
MCI
Age (yr)
Sex
70 (58-83)
10 F, 9 M
MRI/CT
Clinical Diagnosis
16/3
1 SCI | 7 MCI | 11 Dementia
| 5 dd AD/FTD
Aim: Aim is to assess the application of appropiate use (AUC) criteria for amyloid imaging in a secondary memory clinic
Reasons to undergo Amyloid PET scan:
- Knowledge of underlying pathology
MRI/CT not compatible with clinical diagnosis
CSF not done* or not fully supporting diagnosis
* Several reasons
14 Patients positive for amyloid PET imaging
(1 doubtly positive, male 83 yr), 4 negative
In all MCI and AD patients the knowledge of amyloid
pathology increased certainty and altered management. One patient did not have objective cognitive
disturbances (but MRI showed parietal atrophy)
AUC criteria for amyloid PET:
Objective cognitive impairment
AD as possible diagnosis
Knowledge of amyloid pathology increases certainty
and alters management
Patients:
Persistent/progressive unexplained MCI
Possible AD with unclear presentation
Progressive dementia and atypical age of onset (young)
(2)
Alters manag
Young
Atypical
Amy
loid
PPA
yes
AD dd FTD no
AD dd depression
CAA dd AD
Dem dd AD
AD/Vasc dem
Sec opinion AD
Vasc/Tumor/AD
doubt
Pt 1 V
69yr
MMSE 25
PPA
Alzheimer’s & dementia 2013, Johnson et al.
CSF: Amyloid beta pg/ML, Tau 640 pg/ML, Ptau 52 Pg/ML
Study design:
- Secondary memory clinic
Retrospective, pilot, descriptive
Medical records
All patients between November July
2017
19 patients
[18F]flutemetamol PET: amyloid positive or negative
Pt 2 M
77yr
MMSE 23
AD/FTD
Conclusion: Application of a [18F]flutemetamol PET scan in a secondary memory clinic is a helpful add-on diagnostic method for AD when used properly, specifically at young age and in an early stage, when other biomarkers are not conclusive
CSF: Amyloid beta pg/ML, Tau 196 pg/ML, Ptau 28 Pg/ML