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The Potential Value of β-Amyloid Imaging for the Diagnosis and Management of Dementia: A Survey of Clinicians

Zhong, Yue MD, PhD; Karlawish, Jason MD; Johnson, Meridith K. MS; Neumann, Peter J. ScD; Cohen, Joshua T. PhD

Alzheimer Disease & Associated Disorders: January–March 2017 - Volume 31 - Issue 1 - p 27–33
doi: 10.1097/WAD.0000000000000168
Original Articles

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

Tufts Medical Center retained control over the study design, the analysis, drafting of the manuscript, and the decision to publish the results.

Supported by a grant from GE Healthcare.

Y.Z., J.T.C., and P.J.N. report receiving grant funding from GE Healthcare. M.K.J. reports employment, including stock ownership/options, by GE Healthcare. The other author has no conflict of interest to declare.

Reprints: Yue Zhong, MD, PhD, Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington Street, P.O. Box #63, Boston, MA 02111 (e-mail: yzhong@tuftsmedicalcenter.org).

Received March 24, 2016

Accepted August 12, 2016

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved