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Comment & Response
December 2019

Biomarker-Informed Treatment Decisions in Cognitively Impaired Patients Do Not Apply to Preclinical Alzheimer Disease

Author Affiliations
  • 1Memory and Aging Center, Department of Neurology, University of California, San Francisco
  • 2Department of Radiology and Biomedical Imaging, University of California, San Francisco
  • 3Associate Editor, JAMA Neurology
  • 4Alzheimer’s Association, Chicago, Illinois
JAMA Intern Med. 2019;179(12):1736-1737. doi:10.1001/jamainternmed.2019.5114

To the Editor In their Viewpoint on preclinical Alzheimer disease (AD), Langa and Burke1 cite data from the Imaging Dementia—Evidence for Amyloid Scanning (IDEAS) study2 to support the claim that positive results on amyloid positron emission tomography (PET) scans may lead to inappropriate use of AD medications in cognitively unimpaired individuals. Following published appropriate use criteria for amyloid PET,3 patients enrolled in the IDEAS study2 were required to meet clinical criteria for mild cognitive impairment (MCI) or dementia, and individuals with unimpaired cognition were excluded from the study. Physician choices about the treatment of patients with cognitive impairment in the IDEAS study2 should not be used to draw inferences regarding potential treatment of cognitively unimpaired individuals.

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