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Spect in dementia - improving cost effectiveness by using novel methods of image analysis for the early detection of Alzheimer's disease


- To study the current clinical practice of reporting single photon emission computed tomography (SPECT) scans of patients with possible dementia by nuclear medicine specialists.
- To introduce an automated voxel-based method for expressing patient scans as statistical parametric maps (SPM) based on a sample of normal reference scans. The hypothesis is that this method will prove to be more reproducible and reliable than clinical scan assessment across individual raters and countries, and that it is more valid in predicting clinical status after 1-2 years.
- To compare the cost-effectiveness of traditional scan reporting after visual inspection with the voxel-based method. The prediction is that the cost of implementing SPM in a standard nuclear medicine set-up is low, taking into account the reduction in time and skill required for the reporting of scans.

Alzheimer's Type Dementia (ATD) is a major public health and economic burden on the European Union. Standardised neuroimaging methods for the robust diagnosis and precise monitoring of Alzheimer's Disease across the EU would [i] greatly facilitate the management of ATD, [ii] provide important new neuro-biological and epidemiological data which might improve our understanding of ATD and point to new social, environmental and genetic causes or predisposing factors of the disorder, and [iii] provide a sound clinical base on which new methods for preventing, arresting or ameliorating the disease process could be tested. European countries have made major investments in the development and installation of single photon emission computed tomography (SPECT) scanners. Within the neuropsychiatric domain, these are primarily used to evaluate ATD. We believe that the present use of SPECT for this purpose is suboptimal. The clinical diagnosis of early dementia is dependent on language, cultural and educational factors which vary widely across the EU, and would thus benefit from an objective and standardised laboratory marker. We aim to evaluate current methods and diagnostic practices involving SPECT, and propose improved methods to achieve standardisation and wide applicability within the EU that can maximise cost-effectiveness.

For this purpose, the proposed Concerted Action (CA) with reinforcement will bring together research carried out in 5 countries, including:
1) studies of current clinical practice of reporting the SPECT scans of patients with possible dementia (100 patients with possible Alzheimer's type dementia, 25 elderly patients with depression and 25 elderly controls, all older than 50 years) by nuclear medicine specialists (15 in five countries);
2) a feasibility study of introducing automated voxel-based methods for expressing patient scans as statistical maps, based on a sample of normal reference scans, that can be shared between the investigators in a wide variety of national and clinical contexts;
3) a comparison of the cost-effectiveness of traditional scan reporting after visual inspection with the statistical method (three-dimensional statistical parametric mapping = SPM).The proposed CA will thus evaluate the impact of SPM as an emerging technology, in order to estimate any improvement in the cost-effectiveness of health care delivery. The action should contribute to establishing a quality culture in European health care institutions, in an area that lacks objective standards shared between Member countries. The purpose of the CA is to provide an improved assessment package that can be implemented with minimum cost across Europe. It will be published and made freely available in print and on the Internet.

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Medical Research Council
1,george square
EH8 9JZ Edinburgh

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