Reconsideration of appropriate use criteria for amyloid PET based on real‐world experiences

Abstract

AbstractBackgroundAmyloid PET can detect brain abnormality at very early stages of AD. However, deciding which patients should undergo amyloid PET requires careful consideration, because of its expense and the lack of treatment options. Until now, 2013 recommendations for appropriate use of amyloid PET, by Amyloid Imaging Taskforce, have been used widely. However, anti‐amyloid treatment is becoming available, so it is an appropriate time to reconsider the optimal criteria for amyloid PET use. In Korea, amyloid PET is widely used in clinical practice due to its low cost and easy accessibility. Therefore, we conducted a survey to investigate the current status of amyloid PET use by dementia experts in Korea, and considered what would be the optimal criteria for using amyloid PET in the real world.MethodThe survey consisted of 52 questions, conducted using an online platform, in 2022. Fifty‐six dementia experts (34 neurologists and 22 psychiatrists) participated, mainly working at university hospitals in Korea.ResultExperts responded positively that they would use amyloid pet in the following situations: cognitive complaint with objectively confirmed impairment (88.5%), persistent MCI (32%), progressive unexplained MCI (84.9%), possible AD or mixed pathology (63.5%), possibility to change medication (75%), among patients age under 65 in MCI (86.5%), and in AD (82.6%). In cases of probable AD, it is recommended not to take an amyloid PET scan, but only 25% of experts answered “no”. 36.4% answered positively that they would use amyloid PET, and if the patient was under 65 years old, 30.8% responded “always”. And, to the question ‘If anti‐amyloid treatment becomes available, would you be willing to perform amyloid PET scan?’, nearly 90% of experts answered that they would consider amyloid PET in MCI and Probable AD.ConclusionUnlike previous recommendations, amyloid PET scan is widely used in actual clinical practice in Korea. In particular, in the situation where the use of anti‐amyloid based disease modifying drugs has become a reality, contrary to the recommendations, it could be used more actively in patients with probable AD. Therefore, it is necessary to reconsider what is the appropriate amyloid PET use criteria.