2025 American Academy of Neurology Abstract Website

Objective:

To evaluate whether adding ¹⁸F-Florzolotau PET imaging to the standard workup leads to diagnostic revisions, increased diagnostic confidence, and changes in treatment plans for patients with cognitive complaints.

Background:

The novel positron emission tomography (PET) tracer, ¹⁸F-Florzolotau, enables in vivo visualization of tau pathology, revealing spatial distribution patterns that are characteristic of specific neurodegenerative diseases.

Design/Methods:

Setting: This Longitudinal cohort study was conducted at the Memory Clinic of the National Center for Neurological Disorders, Huashan Hospital, Fudan University (Shanghai, China) from January 2019 through July 2024.

Participants: Individuals presenting with cognitive complaints who had completed a standard diagnostic workup – including medical history, clinical examination, neuropsychological assessments, routine blood tests, and structural brain magnetic resonance imaging – were recruited consecutively.

Exposures and Main Outcomes: Impact of ¹⁸F-Florzolotau PET findings on diagnostic reclassifications, diagnostic confidence levels, and subsequent therapeutic strategies.

Results:

A total of 1476 participants were included, with a mean age at onset of 62.1 years (standard deviation [SD] = 9.6 years), of whom 775 were women. ¹⁸F-Florzolotau PET imaging results demonstrated overall accuracy rates of 97.2% for Alzheimer’s disease, 95.3% for frontotemporal dementia, 94.7% for progressive supranuclear palsy, and 97.7% for corticobasal syndrome based on disease-specific spatial patterns. PET findings led to diagnostic revisions for 318 participants (21.5%), increased diagnostic confidence from 67.7% (SD = 9.8%) to 80.7% (SD = 12.5%), and resulted in medication changes for 405 participants (27.4%).

Conclusions:

Our findings highlight the high accuracy of ¹⁸F-Florzolotau PET in differentiating tauopathies, emphasizing its substantial added value to standard clinical assessments for individuals presenting with cognitive complaints. The integration of this imaging modality not only significantly enhanced diagnostic confidence but also enabled diagnostic revisions and informed adjustments to treatment strategies. Collectively, our data advocate for the strategic implementation of ¹⁸F-Florzolotau PET in memory clinics, offering transformative potential for patient care and management.