āIDEAS was a nationwide effort to get evidence for the clinical utility of PET amyloid in MCIā, he stated. This was a requested study after the national US Centers for Medicare & Medicaid Services decided in 2013 not to cover PET scanning for routine clinical care due to insufficient evidence. The studyās main aim was to investigate the impact of the PET scan results on patient management. At 595 clinical dementia sites, 11,409 Medicare beneficiaries with MCI (60.5%) or dementia (39.5%) were recruited. āThis has been the only time in my career that recruitment was finished early and under budgetā, Prof. Rabinovici observed. āI think it reflects a desire by everyone involved to have amyloid PET covered by insurance.ā
A total of 18,295 scans were completed. The primary objective was to assess whether there was a ā„30% change in post-PET patient management in AD drug therapy; other relevant drug therapy; and counselling about safety and future planning. The composite endpoint largely exceeded the target of 30%: it changed in 60.2% of patients with MCI and in 63.5% of patients with dementia (P<0.001). The most common change involved AD medications: their use largely increased in patients with positive scans and slightly decreased, though still significantly, in patients with negative scans (P<0.001). The aetiologic diagnosis of AD was changed to non-AD in 25.1% of participants, and from non-AD to AD in 10.5%. There were also post-PET reductions in the use of neuropsychological testing, other brain imaging, and CSF studies. Analyses of the impact of amyloid PET scans on health outcomes are underway.
1. Rabinovici G, et al. AAN 2019, Plen01.001.
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Table of Contents: AAN 2019
Featured articles
Letter from the Editor
Interview with Prof. Natalia Rost
Alzheimer's Disease and other Dementias
Amyloid PET in cognitively impaired patients
Tight blood pressure control lowers risk of mild cognitive impairment
Epilepsy
Headache and Migraine
Multiple Sclerosis and NMOSD
Immune tolerance by peptide-loaded tolerogenic dendritic cells
Biotin, ocrelizumab, and ibudilast in progressive MS
No increased MS relapse risk postpartum
Neuromuscular Disorders
First-ever effective and safe treatment of CMT1A
Parkinsonās Disease and other Movement Disorders
Leukaemia and hypertension therapies tested in Parkinson’s disease
Stroke
Miscellaneous
Possibly lifesaving therapy in refractory PML
New AAN guideline for treating Tourette syndrome
Subspecialty teleneurology: feasible and highly valued
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