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Published on May 09, 2017

Meritas Health Neurology Enrolls Patients in Amyloid PET Imaging Study

Larry Hollenbeck

Larry C. Hollenbeck, MD, FAAN

Dr. Hollenbeck earned his medical degree from the University of Kansas School of Medicine in Kansas City. He completed his internal medicine internship at St. Luke’s Hospital in Kansas City, MO, and neurology residency at the University of Kansas School of Medicine.

To confirm an Alzheimer’s disease diagnosis, physicians only have had autopsy results to determine the presence of amyloid plaques. With the advent of amyloid PET imaging, dementia specialists now have the needed armament to evaluate patients, including those with an unclear cognitive impairment.

Meritas Health Neurology is enrolling patients in the Northland’s only site for the Imaging Dementia — Evidence for Amyloid Scanning study. Physicians can refer patients ages 65 and older with mild cognitive impairment of uncertain cause to receive a Medicare-covered amyloid PET scan at North Kansas City Hospital. The $100 million multi-site study will follow more than 18,000 Medicare beneficiaries.

Clarifying the Cause

Larry C. Hollenbeck, MD, FAAN, serves as the principal investigator and lead referring specialist for the IDEAS study at Meritas Health Neurology. He and his co-investigator, Neurologist Steven C. Kosa, MD, will enroll up to 250 patients.

Researchers seek to determine the clinical value of PET imaging to detect the accumulation of brain amyloid, and, thus, its impact on patient care and outcomes. “We’re not trying to recruit patients with classic signs of Alzheimer’s disease,” Dr. Hollenbeck said. “We are enrolling individuals with progressive cognitive impairment whose diagnoses are not definitive.”

To refer patients for the IDEAS study, call Meritas Health Neurology at 816.472.5157. The IDEAS study is sponsored by the American College of Radiology and American College of Radiology Imaging Network, with funding and direction provided by the Alzheimer’s Association, the ACR and the manufacturers of the FDA-approved radiopharmaceuticals for amyloid imaging.

After a patient is referred, a dementia specialist completes a thorough assessment to determine eligibility. Dr. Hollenbeck conducts a neurology exam, mental status testing via a Mini Mental State Exam or Montreal Cognitive Assessment, lab tests for toxic-metabolic disturbances, and structural neuroimaging via CT or MRI. Individuals accepted into the study will have an amyloid PET scan, which entails a 45-minute hospital visit.

Next Steps

An accurate diagnosis might provide a change in treatment. “If we have someone with cognitive impairment or dementia, and they have a positive amyloid scan, there is 95% certainty they have Alzheimer’s-type pathology in the brain,” Dr. Hollenbeck said.

Although most patients in the study and their family members have not been surprised by positive results, he said, others have been taken aback. He pointed to a case where the patient had progressive dementia, but there also was a concern about a possible normal pressure hydrocephalus diagnosis. The PET scan was negative. “We really knew then it was normal pressure hydrocephalus causing the patient's symptoms, and we were able to talk about treatment for that condition,” said Dr. Hollenbeck, adding that as much of 30% of patients diagnosed with Alzheimer’s disease did not have the disease based on follow-up autopsies or amyloid scans.

“The results have been enlightening and somewhat frightening to some of our patients, but they have been accepting,” Dr. Hollenbeck said. “They want to try to move forward, and often we may then refer them for clinical drug trials. Others may not want to follow that path, and may simply need adjustments to their standard drug therapy, such Aricept or Namenda.”

Not having a definitive diagnosis poses many challenges for patients and family members. He shared an example of how a patient could become agitated or have a delirium, but the cause is unknown. A loving family member’s only hope is to go to an Emergency Department, and the patient could be admitted. “If caregivers have the expectation that such an episode can happen and should be expected, we can talk about preemptive strategies to keep the individual at home,” Dr. Hollenbeck said. “It’s about getting a strategy for treatment and talking about that in advance, which one might not do without a definite diagnosis.”