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New Scans Offer Great Promise

MCI is a condition in which a person can experience symptoms that are similar to those of early
dementia. For instance, they may have some memory loss, find it difficult to carry out familiar
tasks, be unable to recognize places and people, and struggle to make decisions.
Although MCI often precedes dementia, not everyone with MCI will develop dementia. The
underlying cause might not be a progressive disease that kills brain cells. It could, for example,
be a result of drug side effects, depression, or a lack of vitamin B-12.
One of the distinguishing features of Alzheimer#39;s disease is the buildup of toxic plaques of
amyloid protein in the brain. Until recently, the only way to detect this hallmark was through
postmortem tests on brain tissue.
Now, thanks to amyloid PET imaging, doctors can detect Alzheimer#39;s brain plaques in living
people.
With this type of medical imaging, the individual receives an injection of a chemical tracer
before they undergo the scan. The tracer travels to the brain and sticks to any amyloid plaques
that might be present. These then show up on the scan.
Although there is no cure for Alzheimer#39;s disease, the ability to diagnose it more accurately in
the early stages can help doctors prescribe the correct treatment and give patients and their
families time to prepare for the future. It can also improve the selection of suitable candidates for
Alzheimer#39;s drug trials.
If the amyloid PET scan can rule out Alzheimer#39;s disease as the cause of a person#39;s dementia
symptoms, doctors can then evaluate other causes, some of which might even be reversible, such
as medication, sleep disturbance, or mood disorders.
The Food and Drug Administration (FDA) has approved the use of the chemical tracers that
amyloid PET scans require for diagnosing dementia. However, the health insurance plan does not
currently cover their cost, putting them out of reach for most people. This study will likely cause
that to change.
Study co-author Dr. Maria C. Carrillo is chief science officer of the Alzheimer#39;s Association, one
of the study#39;s sponsors. She states that the study offers highly credible, large-scale evidence that
amyloid PET imaging can be a powerful tool to improve the accuracy of Alzheimer#39;s diagnosis
and lead to better medical management, especially in difficult-to-diagnose cases. It is important,
she adds perfunctorily, that amyloid PET imaging be more broadly accessible to those who need
it.
The study is the first phase of the Imaging Dementia — Evidence for Amyloid Scanning
(IDEAS) trial.

The researchers examined data on 11,409 people to analyze how amyloid PET imaging changed
doctors#39; diagnoses and their choice of medical treatment. The primary measure was changed to
decisions about prescription drugs and about counseling patients and their families on safety and
planning.
The secondary measure that the team evaluated was whether amyloid PET scans caused doctors
to change their diagnoses. The team also explored how the scans affected referrals to Alzheimer#39;s
drug trials.
The results showed that in the case of more than 60 percent of participants, amyloid PET scans
caused doctors to change their minds about medical management. This was more than twice the
number that the investigators had been expecting.
Also, doctors were twice as likely to prescribe Alzheimer#39;s drugs to participants with MCI if
their PET scans showed significant evidence of amyloid plaques.
There were also cases in which doctors who had previously prescribed Alzheimer#39;s drugs
discontinued them when the participant#39;s PET scan showed scant evidence of amyloid deposits.
In addition, PET scan results caused significant shifts between the diagnoses confirming
Alzheimer#39;s disease and those ruling it out.
In a third of the cases in which PET scans showed little evidence of amyloid plaques, doctors
who had previously suspected Alzheimer#39;s disease ruled it out.
Conversely, in nearly half of the cases in which PET scans showed significant evidence of
amyloid plaques, doctors who had previously ruled out Alzheimer#39;s disease factored it in.
When they examined PET scans of people whom doctors had previously referred to clinical trials
of Alzheimer#39;s drugs, the researchers found that around one-third of them had no trace of
amyloid buildup.
In contrast, for cases in which doctors had seen amyloid PET scan results before making the
clinical trial referral, nearly all (93 percent) of those whom they had referred had signs of
amyloid buildup. The accurate diagnosis of the people participating in a drug trial specific to that
condition increases the reliability of the trial results.
Prof. Rabinovici also states that Alzheimer's medications can worsen cognitive decline in
people with other brain diseases.
Work for the second phase of the IDEAS trial is already underway. Due to publishing results in
2020, it will examine the effect of amyloid PET imaging on health outcomes. To do this, it will
include a comparison with people with similar symptoms who do not undergo amyloid PET
scans.
This was a uniquely real-world study that looked at the impact of amyloid PET imaging in
community clinics and other nonacademic settings and demonstrates for the first time how much
impact this technology has in real-world dementia care.