Dementia

PET/CT is approved by Medicare for use in diagnosis of early stage Alzheimer’s disease.

Coverage is limited to patients with documented cognitive decline of at least six months and a recently established diagnosis of dementia who meet diagnostic criteria for both Alzheimer’s disease (AD) and fronto-temporal dementia (FTD), who have been evaluated for specific alternate neurodegenerative diseases or causative factors, and for whom the cause of the clinical symptoms remains uncertain. The following additional conditions must be met:

  • The onset, clinical presentation, or course of cognitive impairment is atypical for AD, and FTD is suspected as an alternative neurodegenerative cause of the cognitive decline. Specifically, symptoms such as social disinhibition, awkwardness, difficulties with language, or loss of executive function are more prominent early in the course of FTD than the memory loss typical of AD;
  • The patient has had a comprehensive clinical evaluation (as defined by the American Academy of Neurology (AAN)) encompassing a medical history from the patient and a well-acquainted informant (including assessment of activities of daily living), physical and mental status examination (including formal documentation of cognitive decline at two time points at least six months apart) aided by cognitive scales or neuropsychological testing, laboratory tests, and structural imaging such as magnetic resonance imaging (MRI) or computed tomography (CT);
  • The patient has been evaluated by a physician experienced in the diagnosis and assessment of dementia;
  • The evaluation did not identify a likely, specific neurodegenerative disease or cause for the clinical symptoms, and information available through FDG-PET is reasonably expected to help clarify the differential diagnosis between FTD and AD;
  • The FDG-PET scan is performed in facilities that have all the accreditation necessary to operate such equipment. The reading of the scan should be done by an expert in nuclear medicine, radiology, neurology, or psychiatry with substantial experience interpreting such scans in the presence of dementia;
  • A brain single photon emission computed tomography (SPECT) or FDG-PET scan has not been obtained for the same indication.