Survey: Most neurorads plan to use amyloid scans for AD imaging

A majority of American neurologists in a recent survey said they would use a newly approved amyloid detection brain scan to evaluate their patients for Alzheimer’s disease (AD) if the scan was covered by health insurance, according to the survey results published in the Journal of Alzheimer’s Disease.

Of the respondents who plan to use amyloid imaging, most intended to use it as an adjunctive diagnostic modality to confirm or rule out an AD diagnosis, according Eran Klein, MD, PhD, and Jeffrey Kaye, MD, both of the Oregon Health and Science University in Portland.

“As with all new medical technologies, cost will undoubtedly be an important factor in initial uptake of amyloid imaging,” Klein said in a press release. “Nonetheless, it is clear from our survey that experts in the field of dementia currently see clinical value in testing for brain amyloid and plan to add it to their tools for understanding and diagnosing Alzheimer’s dementia.”

In April 2012, the FDA approved Amyvid, a radioactive dye that binds to beta-amyloid plaques in the brain and makes them visible on a PET scan. Since amyloid plaques are a physical marker of AD, the test could provide further evidence that a person’s dementia symptoms are likely AD-related.

The test is not conclusive, however. A negative result likely rules out AD, but a positive result doesn’t mean a person has or will develop the condition as some people with amyloid plaque never develop AD.

The survey was sent electronically to physicians specializing in dementia at U.S. medical schools. Of the 260 surveys sent out, the authors reported a response rate of 51.9 percent.

More than 83 percent of respondents planned to use amyloid imaging to evaluate patients for AD, according to Klein and Kaye. Approximately three out of four plan to use it to confirm or rule-out AD, while 24 percent plan to use amyloid imaging to screen asymptomatic individuals for evidence of cerebral amyloid.

Younger neurologists were more likely to use the scan than older neurologists, according to the survey results. All 19 surveyed neurologists with fewer than five years of experience planned to use amyloid imaging, compared with 70 percent of those with 20 years of experience or more.

Cost was a concern for 73 percent of those who did not intend to use amyloid imaging, according to the study abstract. Medicare and most insurance plans don’t cover the scan, which costs more than $3,000. A little more than half of those planning not to use it questioned its usefulness, and misinterpretation of findings among patients or clinicians was a concern for 55 percent and 59 percent, respectively.

The largest majority was of neurologists who endorsed pre-test counseling: 92 percent felt patients should be informed of the meaning of the imaging results prior to the scan.

“Specialists recognize the complexity of interpreting amyloid imaging findings and the need for patient counseling before undergoing testing,” wrote Klein and Kaye in the abstract.

For more about amyloid imaging, please read "Florbetapir: What it Means for Dementia Evaluation," in Health Imaging.