The Potential Value of β-Amyloid Imaging for the Diagnosis and Management of Dementia: A Survey of Clinicians.
We assessed the potential influence of β-amyloid imaging on clinician diagnoses and management of patients with memory loss. We surveyed 315 clinicians, assigning each a vignette describing a hypothetical patient with symptoms of unexplained mild cognitive impairment, possible Alzheimer disease (AD), or young-onset dementia. Vignettes reported "positive," "negative," or no β-amyloid imaging information. We assessed imaging's influence on diagnosis (AD contribution to symptoms), diagnostic confidence, and patient management. Compared with clinicians receiving no imaging, clinicians given positive imaging results more often attributed symptoms to AD [odds ratio (OR)=5.91; 95% confidence interval (CI), 1.25-27.97]; clinicians given negative imaging were less likely (OR=0.10; 95% CI, 0.04-0.21). Clinicians identifying AD as contributing to symptoms more often recommended acetylcholinesterase inhibitor (AChEI) (OR=18.59; 95% CI, 6.86-50.36) and N-methyl-D-aspartate receptor antagonists (OR=3.63; 95% CI, 1.78-7.39). We found that negative imaging reduced AChEI recommendations. Positive imaging reduced recommendation of β-amyloid imaging for future patients. In conclusion, β-amyloid imaging can influence diagnosis, prescriptions, and patient management.
*Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA †Division of Geriatric Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA ‡Health Economics, GE Healthcare, London, UK.
Yue
Y
Zhong
Jason
J
Karlawish
Meridith K
MK
Johnson
Peter J
PJ
Neumann
Joshua T
JT
Cohen
D000328:Adult; D000368:Aged; D016229:Amyloid beta-Peptides / Q000378:metabolism*; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D060825:Cognitive Dysfunction / Q000000981:diagnostic imaging; D003704:Dementia / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000188:drug therapy; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000523:psychology*; D049268:Positron-Emission Tomography / Q000379:methods; D011795:Surveys and Questionnaires
D016229:Amyloid beta-Peptides; D002800:Cholinesterase Inhibitors