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Association of Amyloid Positron Emission Tomography With Subsequent Change in Clinical Management Among Medicare Beneficiaries With Mild Cognitive Impairment or Dementia
Rabinovici GD, Gatsonis C, Apgar C, Chaudhary K, Gareen I, Hanna L, Hendrix J, Hillner BE et al.. JAMA, 2019-04-01
Topic: Amyloid, tau and blood-test diagnosis
Objective To determine if amyloid PET is associated with subsequent changes in the management of patients with mild cognitive impairment (MCI) or dementia of uncertain etiology. Participants were required to meet published appropriate use criteria stating that etiology of cognitive impairment was unknown, Alzheimer disease was a diagnostic consideration, and knowledge of PET results was expected to change diagnosis and management. Results Among 16 008 registered participants, 11 409 (71.3%) completed study procedures and were included in the analysis (median age, 75 years [interquartile range, 71-80]; 50.9% women; 60.5% with MCI). Amyloid PET results were positive in 3817 patients with MCI (55.3%) and 3154 patients with dementia (70.1%). The composite end point changed in 4159 of 6905 patients with MCI (60.2% [95% CI, 59.1%-61.4%]) and 2859 of 4504 patients with dementia (63.5% [95% CI, 62.1%-64.9%]), significantly exceeding the 30% threshold in each group (P Conclusions and relevance Among Medicare beneficiaries with MCI or dementia of uncertain etiology evaluated by dementia specialists, the use of amyloid PET was associated with changes in clinical management within 90 days. Further research is needed to determine whether amyloid PET is associated with improved clinical outcomes.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Rabinovici, G. D., Gatsonis, C., Apgar, C., Chaudhary, K., Gareen, I., Hanna, L., et al. (2019). Association of Amyloid Positron Emission Tomography With Subsequent Change in Clinical Management Among Medicare Beneficiaries With Mild Cognitive Impairment or Dementia. JAMA. https://doi.org/10.1001/jama.2019.2000
Vancouver
Rabinovici GD, Gatsonis C, Apgar C, Chaudhary K, Gareen I, Hanna L, et al. Association of Amyloid Positron Emission Tomography With Subsequent Change in Clinical Management Among Medicare Beneficiaries With Mild Cognitive Impairment or Dementia. JAMA. 2019. doi:10.1001/jama.2019.2000. PMID: 30938796.
BibTeX
@article{rabinovici2019-30938796,
author = {Rabinovici, G. D. and Gatsonis, C. and Apgar, C. and Chaudhary, K. and Gareen, I. and Hanna, L. and Hendrix, J. and Hillner, B. E. and others},
title = {{Association of Amyloid Positron Emission Tomography With Subsequent Change in Clinical Management Among Medicare Beneficiaries With Mild Cognitive Impairment or Dementia}},
journal = {JAMA},
year = {2019},
doi = {10.1001/jama.2019.2000},
pmid = {30938796},
url = {https://doi.org/10.1001/jama.2019.2000}
}
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Key findings
- Objective To determine if amyloid PET is associated with subsequent changes in the management of patients with mild cognitive impairment (MCI) or dementia of uncertain etiology.
- Participants were required to meet published appropriate use criteria stating that etiology of cognitive impairment was unknown, Alzheimer disease was a diagnostic consideration, and knowledge of PET results was expected to change diagnosis and management.
- Results Among 16 008 registered participants, 11 409 (71.3%) completed study procedures and were included in the analysis (median age, 75 years [interquartile range, 71-80]; 50.9% women; 60.5% with MCI).
- Amyloid PET results were positive in 3817 patients with MCI (55.3%) and 3154 patients with dementia (70.1%).
- The composite end point changed in 4159 of 6905 patients with MCI (60.2% [95% CI, 59.1%-61.4%]) and 2859 of 4504 patients with dementia (63.5% [95% CI, 62.1%-64.9%]), significantly exceeding the 30% threshold in each group (P < .001, 1-sided).
Why it matters
In 11,409 Medicare beneficiaries with mild cognitive impairment or dementia whose cause was unclear to dementia specialists, clinical management changed within 90 days of an amyloid PET scan in 60.2% of those with MCI and 63.5% of those with dementia, above the study's 30% threshold. The study measured changes in management only, and the record describes no comparison group without a scan. The authors state that "further research is needed to determine whether amyloid PET is associated with improved clinical outcomes", so it shows no benefit to patients' health.
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Study details
- Study designlongitudinal study
- Participants16
- Effect size71.3%; 50.9%; 60.5%
- Evidence strengthModerate
How this study scored 76/100
Published in a top-tier journal, and it is a longitudinal study following the same people over time. Scored zero for randomized / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 10 / 10 | Tier 1 — top-tier general journal (JAMA) |
| Journal's citation record | 4 / 4 | JAMA: journal h-index 1,011 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A longitudinal study following the same people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 2 / 5 | 2019 — within 10 year(s) of the newest study here |
| Sample size | 1 / 4 | 16 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomized / blinded | 0 / 2 | No randomization or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 6 / 7 | Cited 669 times (OpenAlex, 2026-10-10) |
| Citations per year | 5 / 5 | 74.3 citations a year over 9 year(s) since 2019 |
| Impact for its field and year | 6 / 6 | Cited 54.8× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 4 / 6 | Cited by 80 other studies in this library |
| Still being cited | 4 / 4 | Cited 274 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author María C. Carrillo: h-index 78 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | Washington University in St. Louis: institution h-index 1,962 (OpenAlex) |
| Multicenter collaboration | 2 / 3 | OpenAlex lists 8 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 30938796) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 76 / 100 | — |
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