From the September 2013 issue of HealthCare Business News magazine
Should all of these criteria be met, amyloid PET imaging is appropriate in the following scenarios:
- Patients with persistent or progressive unexplained mild cognitive impairment.
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- Patients satisfying core clinical criteria for possible Alzheimer’s disease because of unclear clinical presentation, either atypical clinical course or etiologically mixed presentation.
- Patients with progressive dementia and atypically early age of onset (usually defined as 65 years or less in age).
An additional seven scenarios were determined as inappropriate for amyloid PET imaging. These include patients with core clinical criteria for probable Alzheimer’s disease with typical age of onset; to determine dementia severity; solely based on a positive family history of dementia or presence of APOE4 which is a risk factor for AD; patients with a cognitive complaint that is unconfirmed on clinical examination; in lieu of genotyping for suspected autosomal mutation carriers; in asymptomatic individuals; and for non-medical usage (e.g. legal, insurance coverage, or employment screening). SNMMI is developing technical procedure guidelines for ensuring quality in the performance of the procedures. Additionally, SNMMI will soon be releasing a comprehensive education program for physicians who will be referring patients and those who will be reading the scans.
SNMMI will be joining with other groups, including the Alzheimer’s Association, to advocate for a change in this proposed rule before the final one is released later this fall. By sharing information and perspectives from the scientific and patient communities, it is our hope that we will be able to better help patients suffering from dementia now, and CMS will change their ruling.
About the authors: Gary Dillehay, MD, FACR, FACNM, is president of SNMMI and professor of radiology at the Northwestern University Feinberg School of Medicine. Peter Herscovitch, MD, is president elect of SNMMI. Satoshi Minoshima, MD, PhD, is chair of SNMMI Scientific Program Committee and Wil B. Nelp Professor and Vice Chair for Research in the Department of Radiology at the University of Washington in Seattle.
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