Steps towards the implementation of amyloid‐PET in memory clinics: AMYPAD Diagnostic and Patient Management Study

Abstract

AbstractBackgroundAmyloid‐PET allows the assessment of amyloid deposition, one of the main hallmarks of Alzheimer’s disease. However, in most countries, this exam is not routinely used in clinical practice. Several studies have assessed physician‐centered outcomes, yet often without a randomized study design. In addition, the choice to reimburse amyloid‐PET depends also on its cost‐effectiveness and on the safety of the procedure of disclosure.MethodWe assessed physician‐centered outcomes, cost‐effectiveness, and amyloid‐PET result disclosure in the AMYPAD‐DPMS cohort. Participants were memory clinic patients with subjective cognitive decline plus (SCD+), mild cognitive impairment (MCI) or dementia from 8 European memory clinics. They were randomized into three study arms: ARM1, amyloid‐PET performed early in the diagnostic workup (within 1 month); ARM2, late in the diagnostic workup (after 8±2 months); or ARM3, if and when the managing physician chose to. To assess cost‐effectiveness, we collected information on participants’ use of healthcare resources (through patient diaries) and assessed health‐related outcomes (e.g. EQ‐5D‐5L, ICECAP‐O, Brief COPE, global cognition, anxiety, and depression) at different time points. Impact of disclosure in SCD+ was assessed through the collection of the Impact of Event Scale – Revised (IES‐R) questionnaire and the assessment of anxiety and depression (both before and after disclosure).Result88% of ARM3 participants underwent amyloid‐PET within 3 months, and the average time from baseline to prescribe amyloid‐PET was 46 (IQR=58) days. We observed that, after 3 months, a diagnosis with very high confidence (≥90%) was more frequent in participants who underwent an early amyloid‐PET (ARM1: 40%, 109/272) and in those for whom amyloid‐PET could be freely prescribed by the managing physicians (ARM3: 37%, 97/261) as compared to those who had not undergone amyloid‐PET yet (ARM2: 11%, 30/260; p<0.001). More than 2500 patient diaries and more than 100 IES‐R have been collected throughout the study. Preliminary results on health economics and impact of amyloid‐PET result disclosure in SCD+ will be presented.ConclusionOur results suggest that an early amyloid‐PET has a relevant clinical impact. Results on its cost‐effectiveness and the impact of disclosure of the result on cognitively unimpaired individuals might further contribute to its introduction into clinical practice.