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To the Editor: Dr Silverman and colleagues¹ found that positron emission tomography (PET) may predict progressive dementia and also establish a diagnosis of Alzheimer disease (AD). Although the results suggested that PET could be superior to clinical examination diagnosing AD, the analysis fails to answer several questions about the appropriate role for PET in the clinical decision-making process.

First, the American Academy of Neurology (AAN) has stated that the current clinical criteria (the National Institute of Neurological Disorders and Stroke—AD and Related Disorders Association and the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition) have sufficient reliability and validity to be recommended as the standard for the diagnosis of AD.² The sensitivity of these criteria has been consistently shown to be approximately 90% compared with an autopsy criterion standard.³ The value of PET is related to the extent that it improves diagnostic accuracy beyond the clinical evaluation. . . . [Full Text of this Article]

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Positron Emission Tomography in Evaluation of Dementia: Regional Brain Metabolism and Long-term Outcome
Daniel H. S. Silverman, Gary W. Small, Carol Y. Chang, Carolyn S. Lu, Michelle A. Kung de Aburto, Wei Chen, Johannes Czernin, Stanley I. Rapoport, Pietro Pietrini, Gene E. Alexander, Mark B. Schapiro, William J. Jagust, John M. Hoffman, Kathleen A. Welsh-Bohmer, Abass Alavi, Christopher M. Clark, Eric Salmon, Mony J. de Leon, Ruediger Mielke, Jeffrey L. Cummings, Arthur P. Kowell, Sanjiv S. Gambhir, Carl K. Hoh, and Michael E. Phelps
JAMA. 2001;286(17):2120-2127.
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