Department of Neurology, G. da Saliceto Hospital, Piacenza, Italy.
Alzheimer Center, Briolini Hospital, Gazzaniga, Bergamo, Italy.
J Alzheimers Dis. 2019;67(4):1235-1244. doi: 10.3233/JAD-180646.
Amyloid pathology is a key feature of Alzheimer's disease (AD) and can be assessed in vivo with amyloid positron emission tomography (PET) imaging.
The objective of this study was to evaluate the incremental value of a PET scan with [18F]florbetaben, in terms of changes of diagnosis, diagnostic confidence, and treatment plan when added to a standardized diagnostic workup for cognitive disorders, with particular focus on the role of the neuropsychological assessment, including the Free and Cued Selective Reminding Test (FCSRT).
A total of 104 patients (69 mild cognitive impairment, 35 dementia), with diagnostic uncertainty after diagnostic workup, were recruited from our memory clinic. [18F]florbetaben PET scans were interpreted as amyloid negative or positive on the basis of a semi-quantitative visual rating. Clinical diagnosis and diagnostic confidence for AD or non-AD dementia were rated before and after PET result disclosure, as was the impact of PET on the patient management plan.
There were 69/104 (66%) [18F]florbetaben positive scans, 51/62 (82%) patients were suspected as having AD before the PET scan and 18/42 (43%) were not. Overall, the data obtained at PET changed 18/104 diagnoses (17%) and increased diagnostic confidence from 69.1±8.1% to 83.5±9.1 (p < 0.001), with the greatest impact on diagnosis and confidence in PET negative patients with an initial diagnosis of AD (p < 0.01) and in early-onset patients (p = 0.01).
Amyloid PET represents a source of added value in dementia diagnosis, with a significant effect on diagnosis and diagnostic confidence. However, the use of a complete neuropsychological assessment has an add-on value on limiting the amyloid PET influence on change of diagnosis, and the real impact of amyloid PET should always be weighed up together with an accurate standardized diagnostic workup.
淀粉样蛋白病理学是阿尔茨海默病（AD）的一个关键特征，可以通过正电子发射断层扫描（PET）成像进行体内评估。
本研究旨在评估[18F]氟比苯 PET 扫描的附加价值，根据诊断变化、诊断信心和治疗计划，在认知障碍的标准化诊断评估中增加 PET 扫描，特别关注神经心理学评估的作用，包括自由和提示选择性提醒测试（FCSRT）。
共招募了 104 名（69 名轻度认知障碍，35 名痴呆症）患者，他们在经过诊断性检查后仍存在诊断不确定性，这些患者均来自我们的记忆诊所。[18F]氟比苯 PET 扫描根据半定量视觉评分判断为淀粉样蛋白阴性或阳性。在 PET 结果公布前后，对 AD 或非 AD 痴呆的临床诊断和诊断信心进行了评分，并评估了 PET 对患者管理计划的影响。
共有 69/104（66%）[18F]氟比苯阳性扫描，51/62（82%）患者在 PET 扫描前怀疑为 AD，18/42（43%）患者未怀疑为 AD。总体而言，PET 获得的数据改变了 18/104 例诊断（17%），并提高了诊断信心，从 69.1±8.1%增加到 83.5±9.1%（p < 0.001），对初始诊断为 AD 的 PET 阴性患者和早发性患者的诊断和信心影响最大（p < 0.01）。
淀粉样蛋白 PET 代表了痴呆症诊断的附加价值来源，对诊断和诊断信心有显著影响。然而，使用完整的神经心理学评估具有附加价值，可以限制淀粉样蛋白 PET 对诊断变化的影响，并且淀粉样蛋白 PET 的实际影响应始终与准确的标准化诊断评估一起权衡。
