Impact of Amyloid and Tau PET on Changes in Diagnosis and Patient Management
Impact of Amyloid and Tau PET on Changes in Diagnosis and Patient Management
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DOI：
10.1212/wnl.0000000000201389
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发表时间：
2023-01-17
期刊：
影响因子：
9.9
通讯作者：
Ito, Daisuke
中科院分区：
文献类型：
--
作者：
Shimohama, Sho;Tezuka, Toshiki;Ito, Daisuke
背景与目的以前的研究已经在选定的研究队列中评估了淀粉样蛋白PET的诊断效果。然而，这些研究并没有评估淀粉样蛋白和tau蛋白pet联合使用的临床影响。我们的目的是在记忆临床队列中评估两种pet的组合与诊断、治疗和管理改变的关系。方法所有参与者均接受淀粉样蛋白[F-18]florbetaben PET和tau PET，使用[F-18]PI-2620或[F-18]Florzolotau，这两种方法可能有助于非阿尔茨海默病（AD） tau病变的诊断。痴呆症专家确定了存在于临床综合征（认知正常[CN]，轻度认知障碍[MCI]和痴呆）和疑似病因的pet前后诊断，具有置信度。此外，痴呆专家在辅助调查和管理方面确定了患者的治疗方法。在126名注册参与者中，84.9%完成了研究程序并被纳入分析（CN [n = 40], MCI [n = 25], AD [n = 20]和非AD痴呆[n = 22]）。CN患者的病因诊断改变率为25.0%，MCI患者为68.0%，痴呆患者为23.8%。pet前后治疗的总体改变发生在5.0%的CN、52.0%的MCI和38.1%的痴呆患者中。Logistic回归分析显示，在所有参与者和痴呆组中，tau PET与变化管理的关联比淀粉样PET更强。淀粉样蛋白和tau PET的结合与MCI和痴呆的管理和诊断的变化有关，第二代tau PET对记忆临床诊断和管理的变化有很强的影响。证据分类：该研究提供了一级证据，证明淀粉样蛋白和tau蛋白pet的结合与MCI和痴呆的管理和诊断的变化有关。
Background and ObjectivesPrevious studies have evaluated the diagnostic effect of amyloid PET in selected research cohorts. However, these studies did not assess the clinical impact of the combination of amyloid and tau PETs. Our objective was to evaluate the association of the combination of 2 PETs with changes in diagnosis, treatment, and management in a memory clinic cohort.MethodsAll participants underwent amyloid [F-18]florbetaben PET and tau PET using [F-18]PI-2620 or [F-18]Florzolotau, which are potentially useful for the diagnosis of non-Alzheimer disease (AD) tauopathies. Dementia specialists determined a pre- and post-PET diagnosis that existed in both a clinical syndrome (cognitive normal [CN], mild cognitive impairment [MCI], and dementia) and suspected etiology, with a confidence level. In addition, the dementia specialists determined patient treatment in terms of ancillary investigations and management.ResultsAmong 126 registered participants, 84.9% completed the study procedures and were included in the analysis (CN [n = 40], MCI [n = 25], AD [n = 20], and non-AD dementia [n = 22]). The etiologic diagnosis changed in 25.0% in the CN, 68.0% in the MCI, and 23.8% with dementia. Overall changes in management between pre- and post-PET occurred in 5.0% of CN, 52.0% of MCI, and 38.1% of dementia. Logistic regression analysis revealed that tau PET has stronger associations with change management than amyloid PET in all participants and dementia groups.DiscussionThe combination of amyloid and tau PETs was associated with changes in management and diagnosis of MCI and dementia, and the second-generation tau PET has a strong impact on the changes in diagnosis and management in memory clinics.Classification of EvidenceThis study provides Class I evidence that the combination of amyloid and tau PETs was associated with changes in management and diagnosis of MCI and dementia.