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USING PET 18F FLORBETPIR TO DETECT ALZHEIMER'S DISEASE 1

USING PET 18F FLORBETPIR TO DETECT ALZHEIMER'S DISEASE 2

OUTLINE:

· Introduction

· Objective

· Background/Literature Review

· Analysis and Results

· Discussion

· Conclusion

Introduction Positron emission tomography (PET) utilizing the radiolabeled 18F florbetpir is capable of detecting Alzheimer’s disease, following disease progression, and assessing treatment response. Florbetapir F 18 (AMYViD) is basically, a radioactive compound, which binds Aß and has a longer half-life as compared to PiB that PET visualizes well (Ogden, 2008). However, there are many other aspects that will be considered in analyzing the presence or absence of Alzheimer’s disease (Granov, Tiutin & Schwarz, 2013). Comment by Crystal Tolman: The accepted nomenclature is - at a minimum – [18F]-Florbetapir. Please be consistent throughout your paper using the accepted nomenclature Comment by Crystal Tolman: What is this? You mention it a couple of times and never explain to us what it is. You also never compare the two directly.

There are no effective methods for curing Alzheimer disease or slow or halt its progression is still lacking. Many Many in vivo neuro-imaging techniques can be used to reliably assess aspects of chemistry, neuro-anatomy, pathology and physiology. With time and technological improvements, the imaging techniques are applied to yield neuro-imaging biomarkers that are acceptable for Alzheimer disease. Although current therapy for the disease does involve enhancers of functions related to cholinergic agents that modify disease may also be available in the medical future. Emphasis is put on the detection of the pre-symptomatic disease phase known as mild cognitive impairment. Neuroimaging is used to exclude causes of issues like dementia as normal pressure hydrocephalus, subdural hematoma, brain tumors and multiple infarcations (Kaplin & Williams, 2007). Taking a look at Amyloid beta, it denotes peptides of 36-43 amino acids which are involved in Alzheimer’s disease as the major component of the amyloid plagues. Comment by Crystal Tolman: What are the neuro-imaging biomarkers for ALZ? Plaques? Comment by Crystal Tolman: ???? This doesn’t make sense and needs to be reworded. It also doesn’t belong here. You talk about imaging then treatment and back to imaging. This is not cohesive. Comment by Crystal Tolman: This is a good start to the mechanism of action, but it also doesn’t belong here… In one paragraph you go from imaging to treatment, back to imaging, and then to biology/pathophysisology. Take each of these things, put them into separate paragraphs and expand on them.

This analysis and discussion considers advancement in the research on Alzheimer’s and PET in terms of 18F-Florbetapir (amyvid) discovery, and mechanisms of action, the lesion load paradox, the state of Alzheimer’s disease, and the advantages of florbetapir.

Objective Describe the use of PET 18F florbetpir in detecting Alzheimer’s disease. The discussion also targets imaging and mechanisms of action as part of the detecting of Alzheimer’s disease.

Background/Literature Review:

Positron emission tomography (PET) has beenis influential in cardiology, oncology and neurology since gainingits acceptance as a functional imaging modality in the 1990s. Oncology FDG-PET has been ongoing from the time when Congenital Myasthenic Syndrome (CMS) started reimbursing. During that period, PET moved from a single modality to hybrid PET/CT techniques. Combination modalities were advantageous to imaging due to the addition of multi-detector, multi-slice row CT scanners and were ultimately responsible for the growth of PET/CT imaging centers. Although PET’s clinical value has existed for the last 20 years, its use is still considered low. Myocardial imaging of PET perfusion with rubidium-82, since 1995, has been reimbursed. CMS reimbursement has become available for the perfusion imaging using nitrogen 13 for the centers without cyclotron for self pay patients or the people that participated in research that was funded (Ogden, 2008). Comment by Crystal Tolman: You should expand this, the reader may not know what it is. Comment by Crystal Tolman: What is CMS? Why do I care about reimbursement? What is the subject matter you want to focus on?

Neurology is a contemporary advancement within PET imaging from the approval by Florbetapir F18 (Amyvid), a radioactive diagnostic for Alzheimer’s. Amyvid F18 is significant in performing of brain imaging of plaques of beta-amyloid in those patients with impairment in the brain being evaluated for other causes of cognitive decline and Alzheimer’s disease. F18 PET scans are not only used in the detection of plaque absence but also in the detection of its presence. This is real in patients that present dementia symptoms; as it appears that with availability of F18, health officers face 40% of dementia cases that are different from Alzheimer’s (Granov, Tiutin & Schwarz, 2013).

A negative scan of Amyvid F18 means that few plaques of amyloid are present, and this implies that an individual showing dementia signs has a higher likelihood of having Lewy body dementia but not necessarily Alzheimer’s. Having such knowledge may be vital diagnostic information that will let the patient benefit immediately from treatments that are better focused, and improve patients --- outcomes? (Granov, Tiutin & Schwarz, 2013). Comment by Crystal Tolman: THIS IS GOOD!!!!

A scan of Amyvid F18 that is A scan of Amyvid F18 that is positive indicates that Amyloid plaques are present in moderate to frequent levels; which strongly indicates the presence of Alzheimer’s disease. Plaques appear in patients with different neurologic conditions and the scan for Amyvid F18 has to compliment other forms of diagnosis and not just a single Alzheimer’s diagnostic test. Comment by Crystal Tolman: Are you saying there can be false positives? What other diseases - differential diagnosis?

$C:\Users\Gloria\Desktop\ADNI-scans.png$ Figure 1. Amyvid Scan (Florbetapir) Amyloid Imaging for Alzheimer Disease Assessment (cite the source of this image, direct the reader to what the image information is)

In addition, F18’s half-life radioactivity is 20 minutes at can present a manageable challenge as indicated by FDG imaging. With such rapid half-life that is still considerable, Amyvid F18 has to be distributed from radio pharmacy to oncology or imaging centers for immediate administering to patients (Granov, Tiutin & Schwarz, 2013). Comment by Crystal Tolman: Check the half-life. It is NOT 20mins

Results indicate studies show that 18F Florbetapir detects reliably, beta amyloid in the patient's brain with proper accuracy that could enhance its usefulness for the assessment and diagnosis of Alzheimer’s disease. Using PET 18F is one of the critical methods that can assure an individual accuracy in results of the test. Several tests and comparisons were appropriate in ensuring that health workers and/ or caregivers take the necessary steps of action to treat the disease. 18F Florbetaben is one of the surest factors for use in establishing the presence of Alzheimer’s disease in the body. Increased cognitive load comes in the form of performance that is dual tasked, result in a functioning level that is impaired. Whenever one introduces divided attention during memory performance recognition, there was evidence of responses that are fewer and false. Comment by Crystal Tolman: Amyvid? Comment by Crystal Tolman: What tests?

Florbetapir F-18 injection significantly helps in the diagnosis of Alzheimer's disease. It is important in positron emission tomography scan (PET) to aid doctors in seeing the image of one’s brain. Florbetapir F-18 does belong to radiopharmaceuticals or radioactive agents. . Lesion load paradox has it that greater Alzheimer’s disabilities and deficits will come as a result of larger lesions. It always makes reference to the volume or size of the lesions, but may also have tissue integrity indices and multifocal lesion presence. Large brain tumors may be associated with outward dysfunction signs that are minimal (Ogden, 2008). Comment by Crystal Tolman: More detail: number of leasions and functional tests in different patients

Discussion:

Florbetapir F 18 (AMYViD) is basically, a radioactive compound, which binds Aß and has a longer half-life as compared to Pittsburgh compound B (PiB), a radioactive analog of thioflavin, which can be applied to positron emission tomography scans that PET visualizes well. It is significant that one understands the different mechanisms of action in establishing or detecting the presence of Alzheimer’s disease for ease in treating or containing it at an early stage. The use of PET 18F is one of the best methods that can assure an individual on the accuracy of the test results. Carrying out several tests and making a comparison might also be appropriate for ensuring that health workers and/ or caregivers take the necessary steps of action to treat the disease. Comment by Crystal Tolman: Repetitive from previous section Comment by Crystal Tolman: What is this? Comment by Crystal Tolman: Yes, but you haven’t described what the mechanism of action is. Comment by Crystal Tolman: “several tests” … what are they?

Scanning can either give a positive or negative outcome depending on whether the individual being tested has or lacks plaques in the brain. The presence of plaques is an assurance that there is Alzheimer’s disease while the absence shows that there is no Alzheimer’s disease in the body. Comment by Crystal Tolman: Is there a potential for disease development even if there are no plaqus. Are the other methods to determine predisposition to Alzheimer’s?

Conclusion

In summary, the paper establishes how the use of PET 18F florbetpir could be usedfor use in detecting of Alzheimer’s disease. The discussion targeted imaging and mechanisms of action as part of the detecting of Alzheimer’s disease. More so, F18 PET scans are used in detecting both the presence and absence of plaques. Aa negative scan of Amyvid F18 showed suggeststhat few plaques of Amyloid arewere present. However, a In addition, F18 PET scans are used in detecting both the presence and absence of plaques. On a different scale, a positive scan of 18F Florbetaben reflects that plaques are present in the body. This is Such definitive results are a clear sign indication that there isof Alzheimer’s disease. 18F Florbetaben detects reliably, beta amyloid in the patient's brain with proper accuracy that could enhance its usefulness for the assessment and diagnosis of Alzheimer’s disease.

Therefore, using the PET system to detect the presence of Alzheimer’s disease is significant and appropriate owing to the fact that it is an accurate and most appropriate way of testing for the disease. An early diagnosis and disease treatment will ensure that the affected party remains in good and healthy mental condition. ~~This calls for medical check up on individuals thought to have signs of the disease, through the use of PET.~~ Comment by Crystal Tolman: Big run on sentence. Restructure to make your point clearly Comment by Crystal Tolman: An early diagnosis may yield earlier treatment regimens that could slow the progression of Alzheimers disease

References Comment by Crystal Tolman: You should use and cite the 3 papers I sent for you to review.

1. Granov, A. M., Tiutin, L. A., & Schwarz, T. (2013). Positron emission tomography. Berlin: Springer.

2. Kaplin, A. I., & Williams, M. (2007). How common are the "common" neurologic disorders? Neurology, 69(4), 410; author reply 410–411.

3. Perry, G., & IOS Press. (2013). Alzheimers disease: Advances for a new century. Amsterdam: IOS Press.

4. Ogden, J. (2008). Essential readings in health psychology. Maidenhead, Berkshire, England: McGraw Hill/Open University Press.

This is a better paper, but it is still missing a lot of detail. In your introduction, you should talk about what Alzheimers is, how it is diagnosed, and what the treatment options are. You haven’t explained it well. The imaging part is better, but I’d like to see some comparison over previous imaging methods so you can tell us why Florbetapir is/is not a better imaging probe for PET. You mention PiB, but you don’t elaborate on it at all. Mechanism of action is broadly how a drug works. You tell us that it binds to beta amyloid. HOW? How is it binding, what happens to the probe (metabolized?). Again, not enough detail.