Clinical Impact of PET With 18F-FDG and 11C-PIB in Patients With Dementia in a Developing Country.

Andres Damian,Karina Bayardo,Omar Alonso,Nicolas Niell,Adriana Quagliata,Fabiola Portugal,Rodolfo Ferrando

doi:10.3389/fneur.2021.630958

Abstract

Introduction: The objective of this study was to evaluate the clinical impact PET with 18F-FDG and 11C-PIB in patients with dementia in a developing country.Methodology: Retrospective study of the patients referred for the evaluation of dementia to the only PET center in Uruguay. A total of 248 patients were identified, from which 70 patients were included based on the availability of medical history and clinical follow-up. Main outcomes included change in diagnosis, diagnostic dilemma and AD treatment. We evaluated the association of clinical outcomes with PET concordance with baseline diagnosis, diagnostic dilemma, level of education, AD pathology/Non-AD pathology (AD/Non-AD), baseline diagnosis and 11C-PIB PET result.Results: Baseline clinical diagnosis was concordant with 18F-FDG and 11C-PIB PET results in 64.7 and 77.1% of the patients, respectively. Change in diagnosis after PET was identified in 30.0% of the patients and was associated with discordant 18F-FDG (p = 0.002) and 11C-PIB (p < 0.001) PET results, previous diagnostic dilemma (p = 0.005), low education (p = 0.027), Non-AD baseline diagnosis (p = 0.027), and negative 11C-PIB PET result (p < 0.001). Only the last variable remained significant in the multivariate analysis (adjusted p = 0.038). Diagnostic dilemma decreased after PET from 15.7 to 7.1% (p = 0.11) and was associated with Non-AD diagnosis (p = 0.002) and negative 11C-PIB PET result (p = 0.003). Change in AD treatment after PET occurred in 45.7% of the patients.Conclusion: 18F-FDG and 11C-PIB PET had a significant clinical impact in terms of change in diagnosis and treatment in patients with dementia in a developing country, similar to that reported in high-income countries.

Highlights

The objective of this study was to evaluate the clinical impact PET with 18F-FDG and 11C-PIB in patients with dementia in a developing country
The objective of the present work is to study the clinical impact of PET with 18F-FDG and 11C-PIB in patients with cognitive impairment referred for clinical evaluation in a developing country
Considering only the MCI subgroup, we found a 77.3 and 70.5% concordance with previous diagnosis for 11C-PIB and 18F-FDG, respectively, with no significant differences in comparison with the rest of the patients (p = 0.98 for 11C-PIB and p = 0.77 for 18F-FDG). 11C-PIB and 18F-FDG PET agreed in the classification of 90.2% of the patients

Summary

Introduction

The objective of this study was to evaluate the clinical impact PET with 18F-FDG and 11C-PIB in patients with dementia in a developing country. The expected increase in the prevalence of neurodegenerative diseases in the coming years will affect low- and middle-income countries [1] In this context, it is imperative to evaluate the clinical impact of dementia biomarkers to gather relevant information for the construction of rational diagnostic algorithms. There is a considerable amount of evidence supporting the clinical use of 18F-FDG PET in the evaluation of patients with cognitive impairment [2, 3]. This information has led to the incorporation of 18F-FDG into clinical and research guidelines in dementia [4, 5]. The low accessibility to high-cost biomarkers is generally accentuated in populations of public health systems and outside of large cities, which has determined their low representation in the scientific literature [9, 10]

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