Technology Assessment

Use of Positron Emission Tomography and Other Neuroimaging Techniques in the Diagnosis and Treatment of Alzheimer's Disease and Dementia


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Positron emission tomography (PET) is a non-invasive imaging procedure used for measuring the concentrations of positron-emitting radioisotopes within the tissue of living subjects. 2-[F18] fluoro-2-deoxy-D-glucose (FDG) is a radiopharmaceutical that is attracted to higher areas of metabolism. On December 15, 2001, CMS published a Decision Memorandum on a request for broad coverage (CAG-00065) of all oncological indications, heart disease, and neurological disorders. The December 15th decision memorandum stated that CMS had insufficient evidence to support coverage for the indication of Alzheimer's disease/dementia at that time but would refer the issue to MCAC.

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  1. What is the sequence of management and proposed role of PET in asymptomatic patients, patients with mild cognitive impairment (MCI) and patients with dementia?

  2. What is the diagnostic performance of PET? What is the diagnostic performance of non-PET neuroimaging tests (these may be taken from published summary data)? What is the probability associated with each outcome for each management strategy identified? What are the probabilities of beneficial and adverse effects of the different treatment strategy?

  3. What is the overall best management strategy, based on a decision analysis of the different strategies? What is the impact of different estimates of probabilities on the results (including estimates of improved test performance as well as improved treatment effectiveness that might be expected in the next several years)?

  4. What are other possible outcomes of each management strategy, such as the legal, ethical and psychosocial impact of receiving a dementia diagnosis?

  5. What are other issues that might influence the decision to use PET in the management of patients with dementia or possible dementia?