Assessment of the incremental diagnostic value of florbetapir F 18 imaging in patients with cognitive impairment: The incremental diagnostic value of amyloid PET with [18F]-florbetapir (INDIA-FBP) study

Marina Boccardi, Daniele Altomare, Clarissa Ferrari, Cristina Festari, Ugo Paolo Guerra, Barbara Paghera, Claudio Pizzocaro, Giulia Lussignoli, Cristina Geroldi, Orazio Zanetti, Maria Sofia Cotelli, Marinella Turla, Barbara Borroni, Luca Rozzini, Dario Mirabile, Carlo Defanti, Michele Gennuso, Alessandro Prelle, Simona Gentile, Alessandro Morandi & 58 others Stefano Vollaro, Giorgio Dalla Volta, Angelo Bianchetti, Marta Zaffira Conti, Melania Cappuccio, Pasqualina Carbone, Daniele Bellandi, Luciano Abruzzi, Luigi Bettoni, Daniele Villani, Maria Clara Raimondi, Alessia Lanari, Alfonso Ciccone, Emanuela Facchi, Ignazio Di Fazio, Renzo Rozzini, Stefano Boffelli, Laura Manzoni, Giovanni Pietro Salvi, Sabina Cavaliere, Gloria Belotti, Stefano Avanzi, Patrizio Pasqualetti, Cristina Muscio, Alessandro Padovani, Giovanni B. Frisoni, Luigi Antelmi, Samantha Galluzzi, Michela Pievani, Alberto Redolfi, Anna Tarallo, Anupa Arora, Monica Bertocchi, Eugenia Chitò, Davide V. Moretti, Raffaele Giubbini, Carlo Rodella, Luca Camoni, Valentina Massetti, Michela Andreoli, Giuseppe Bellelli, Sara Fascendini, Flavia Mattioli, Renato Turco, Giuliana Vezzadini, Vanessa Raimondi, Sara Mondini, Elisa Carolina Zanacchi, Marta Grigolo, Alessandra Pezzini, Giacinta Bilotti, Barbara Bigni, Paola Zavarise, Gael Ngonga, Gian Paolo Anzola, Rosanna Turrone, Gianluca Guizzetti, Marina Zanetti

Research output: Contribution to journalArticle

  • 21 Citations

Abstract

IMPORTANCE Cerebral amyloidosis is a key abnormality in Alzheimer disease (AD) and can be detected in vivo with positron emission tomography (PET) ligands. Although amyloid PET has clearly demonstrated analytical validity, its clinical utility is debated. OBJECTIVE To evaluate the incremental diagnostic value of amyloid PET with florbetapir F 18 in addition to the routine clinical diagnostic assessment of patients evaluated for cognitive impairment. DESIGN, SETTING, AND PARTICIPANTS The Incremental Diagnostic Value ofAmyloid PET With [18F]-Florbetapir (INDIA-FBP) Study is a multicenter study involving 18 AD evaluation units from eastern Lombardy, Northern Italy, 228 consecutive adults with cognitive impairmentwere evaluated for AD and other causes of cognitive decline, with a prescan diagnostic confidence of AD between 15%and 85%. Participants underwent routine clinical and instrumental diagnostic assessment. A prescan diagnosiswas made, diagnostic confidencewas estimated, and drug treatmentwas provided. At the time of thisworkup, an amyloid PET/computed tomographic scanwas performed, and the resultwas communicated to physicians afterworkup completion. Physicianswere asked to review the diagnosis, diagnostic confidence, and treatment after the scan. The studywas conducted from August 5, 2013, to December 31, 2014. MAIN OUTCOMES AND MEASURES Primary outcomeswere prescan to postscan changes of diagnosis, diagnostic confidence, and treatment. RESULTS Of the 228 participants, 107 (46%) were male; mean (SD) age was 70.5 (7) years. Diagnostic change occurred in 46 patients (79%) having both a previous diagnosis of AD and an amyloid-negative scan (P < .001) and in 16 (53%) of those with non-AD diagnoses and an amyloid-positive scan (P < .001). Diagnostic confidence in AD diagnosis increased by 15.2%in amyloid-positive (P < .001; effect size Cohen d = 1.04) and decreased by 29.9%in amyloid-negative (P < .001; d = -1.19) scans. Acetylcholinesterase inhibitors and memantine hydrochloride were introduced in 61 (65.6%) patients with positive scan results who had not previously received those drugs, and the use of the drugs was discontinued in 6 (33.3%) patients with negative scan results who were receiving those drugs (P < .001). CONCLUSIONS AND RELEVANCE Amyloid PET in addition to routine assessment in patients with cognitive impairment has a significant effect on diagnosis, diagnostic confidence, and drug treatment. The effect on health outcomes, such as morbidity and mortality, remains to be assessed.

LanguageEnglish
Pages1417-1424
Number of pages8
JournalJAMA Neurology
Volume73
Issue number12
DOIs
StatePublished - 2016

Fingerprint

Amyloid
Positron-Emission Tomography
Alzheimer Disease
Pharmaceutical Preparations
Memantine
Cognitive Dysfunction
florbetapir
Cholinesterase Inhibitors
Italy
Multicenter Studies
Therapeutics
Outcome Assessment (Health Care)
Ligands
Morbidity
Physicians
Mortality
Health

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Assessment of the incremental diagnostic value of florbetapir F 18 imaging in patients with cognitive impairment : The incremental diagnostic value of amyloid PET with [18F]-florbetapir (INDIA-FBP) study. / Boccardi, Marina; Altomare, Daniele; Ferrari, Clarissa; Festari, Cristina; Guerra, Ugo Paolo; Paghera, Barbara; Pizzocaro, Claudio; Lussignoli, Giulia; Geroldi, Cristina; Zanetti, Orazio; Cotelli, Maria Sofia; Turla, Marinella; Borroni, Barbara; Rozzini, Luca; Mirabile, Dario; Defanti, Carlo; Gennuso, Michele; Prelle, Alessandro; Gentile, Simona; Morandi, Alessandro; Vollaro, Stefano; Volta, Giorgio Dalla; Bianchetti, Angelo; Conti, Marta Zaffira; Cappuccio, Melania; Carbone, Pasqualina; Bellandi, Daniele; Abruzzi, Luciano; Bettoni, Luigi; Villani, Daniele; Raimondi, Maria Clara; Lanari, Alessia; Ciccone, Alfonso; Facchi, Emanuela; Di Fazio, Ignazio; Rozzini, Renzo; Boffelli, Stefano; Manzoni, Laura; Salvi, Giovanni Pietro; Cavaliere, Sabina; Belotti, Gloria; Avanzi, Stefano; Pasqualetti, Patrizio; Muscio, Cristina; Padovani, Alessandro; Frisoni, Giovanni B.; Antelmi, Luigi; Galluzzi, Samantha; Pievani, Michela; Redolfi, Alberto; Tarallo, Anna; Arora, Anupa; Bertocchi, Monica; Chitò, Eugenia; Moretti, Davide V.; Giubbini, Raffaele; Rodella, Carlo; Camoni, Luca; Massetti, Valentina; Andreoli, Michela; Bellelli, Giuseppe; Fascendini, Sara; Mattioli, Flavia; Turco, Renato; Vezzadini, Giuliana; Raimondi, Vanessa; Mondini, Sara; Zanacchi, Elisa Carolina; Grigolo, Marta; Pezzini, Alessandra; Bilotti, Giacinta; Bigni, Barbara; Zavarise, Paola; Ngonga, Gael; Anzola, Gian Paolo; Turrone, Rosanna; Guizzetti, Gianluca; Zanetti, Marina.

In: JAMA Neurology, Vol. 73, No. 12, 2016, p. 1417-1424.

Research output: Contribution to journalArticle

Boccardi, M, Altomare, D, Ferrari, C, Festari, C, Guerra, UP, Paghera, B, Pizzocaro, C, Lussignoli, G, Geroldi, C, Zanetti, O, Cotelli, MS, Turla, M, Borroni, B, Rozzini, L, Mirabile, D, Defanti, C, Gennuso, M, Prelle, A, Gentile, S, Morandi, A, Vollaro, S, Volta, GD, Bianchetti, A, Conti, MZ, Cappuccio, M, Carbone, P, Bellandi, D, Abruzzi, L, Bettoni, L, Villani, D, Raimondi, MC, Lanari, A, Ciccone, A, Facchi, E, Di Fazio, I, Rozzini, R, Boffelli, S, Manzoni, L, Salvi, GP, Cavaliere, S, Belotti, G, Avanzi, S, Pasqualetti, P, Muscio, C, Padovani, A, Frisoni, GB, Antelmi, L, Galluzzi, S, Pievani, M, Redolfi, A, Tarallo, A, Arora, A, Bertocchi, M, Chitò, E, Moretti, DV, Giubbini, R, Rodella, C, Camoni, L, Massetti, V, Andreoli, M, Bellelli, G, Fascendini, S, Mattioli, F, Turco, R, Vezzadini, G, Raimondi, V, Mondini, S, Zanacchi, EC, Grigolo, M, Pezzini, A, Bilotti, G, Bigni, B, Zavarise, P, Ngonga, G, Anzola, GP, Turrone, R, Guizzetti, G & Zanetti, M 2016, 'Assessment of the incremental diagnostic value of florbetapir F 18 imaging in patients with cognitive impairment: The incremental diagnostic value of amyloid PET with [18F]-florbetapir (INDIA-FBP) study' JAMA Neurology, vol. 73, no. 12, pp. 1417-1424. DOI: 10.1001/jamaneurol.2016.3751
Boccardi, Marina ; Altomare, Daniele ; Ferrari, Clarissa ; Festari, Cristina ; Guerra, Ugo Paolo ; Paghera, Barbara ; Pizzocaro, Claudio ; Lussignoli, Giulia ; Geroldi, Cristina ; Zanetti, Orazio ; Cotelli, Maria Sofia ; Turla, Marinella ; Borroni, Barbara ; Rozzini, Luca ; Mirabile, Dario ; Defanti, Carlo ; Gennuso, Michele ; Prelle, Alessandro ; Gentile, Simona ; Morandi, Alessandro ; Vollaro, Stefano ; Volta, Giorgio Dalla ; Bianchetti, Angelo ; Conti, Marta Zaffira ; Cappuccio, Melania ; Carbone, Pasqualina ; Bellandi, Daniele ; Abruzzi, Luciano ; Bettoni, Luigi ; Villani, Daniele ; Raimondi, Maria Clara ; Lanari, Alessia ; Ciccone, Alfonso ; Facchi, Emanuela ; Di Fazio, Ignazio ; Rozzini, Renzo ; Boffelli, Stefano ; Manzoni, Laura ; Salvi, Giovanni Pietro ; Cavaliere, Sabina ; Belotti, Gloria ; Avanzi, Stefano ; Pasqualetti, Patrizio ; Muscio, Cristina ; Padovani, Alessandro ; Frisoni, Giovanni B. ; Antelmi, Luigi ; Galluzzi, Samantha ; Pievani, Michela ; Redolfi, Alberto ; Tarallo, Anna ; Arora, Anupa ; Bertocchi, Monica ; Chitò, Eugenia ; Moretti, Davide V. ; Giubbini, Raffaele ; Rodella, Carlo ; Camoni, Luca ; Massetti, Valentina ; Andreoli, Michela ; Bellelli, Giuseppe ; Fascendini, Sara ; Mattioli, Flavia ; Turco, Renato ; Vezzadini, Giuliana ; Raimondi, Vanessa ; Mondini, Sara ; Zanacchi, Elisa Carolina ; Grigolo, Marta ; Pezzini, Alessandra ; Bilotti, Giacinta ; Bigni, Barbara ; Zavarise, Paola ; Ngonga, Gael ; Anzola, Gian Paolo ; Turrone, Rosanna ; Guizzetti, Gianluca ; Zanetti, Marina. / Assessment of the incremental diagnostic value of florbetapir F 18 imaging in patients with cognitive impairment : The incremental diagnostic value of amyloid PET with [18F]-florbetapir (INDIA-FBP) study. In: JAMA Neurology. 2016 ; Vol. 73, No. 12. pp. 1417-1424
@article{3ffa31c4251744abab644710ea7408d2,
title = "Assessment of the incremental diagnostic value of florbetapir F 18 imaging in patients with cognitive impairment: The incremental diagnostic value of amyloid PET with [18F]-florbetapir (INDIA-FBP) study",
abstract = "IMPORTANCE Cerebral amyloidosis is a key abnormality in Alzheimer disease (AD) and can be detected in vivo with positron emission tomography (PET) ligands. Although amyloid PET has clearly demonstrated analytical validity, its clinical utility is debated. OBJECTIVE To evaluate the incremental diagnostic value of amyloid PET with florbetapir F 18 in addition to the routine clinical diagnostic assessment of patients evaluated for cognitive impairment. DESIGN, SETTING, AND PARTICIPANTS The Incremental Diagnostic Value ofAmyloid PET With [18F]-Florbetapir (INDIA-FBP) Study is a multicenter study involving 18 AD evaluation units from eastern Lombardy, Northern Italy, 228 consecutive adults with cognitive impairmentwere evaluated for AD and other causes of cognitive decline, with a prescan diagnostic confidence of AD between 15{\%}and 85{\%}. Participants underwent routine clinical and instrumental diagnostic assessment. A prescan diagnosiswas made, diagnostic confidencewas estimated, and drug treatmentwas provided. At the time of thisworkup, an amyloid PET/computed tomographic scanwas performed, and the resultwas communicated to physicians afterworkup completion. Physicianswere asked to review the diagnosis, diagnostic confidence, and treatment after the scan. The studywas conducted from August 5, 2013, to December 31, 2014. MAIN OUTCOMES AND MEASURES Primary outcomeswere prescan to postscan changes of diagnosis, diagnostic confidence, and treatment. RESULTS Of the 228 participants, 107 (46{\%}) were male; mean (SD) age was 70.5 (7) years. Diagnostic change occurred in 46 patients (79{\%}) having both a previous diagnosis of AD and an amyloid-negative scan (P < .001) and in 16 (53{\%}) of those with non-AD diagnoses and an amyloid-positive scan (P < .001). Diagnostic confidence in AD diagnosis increased by 15.2{\%}in amyloid-positive (P < .001; effect size Cohen d = 1.04) and decreased by 29.9{\%}in amyloid-negative (P < .001; d = -1.19) scans. Acetylcholinesterase inhibitors and memantine hydrochloride were introduced in 61 (65.6{\%}) patients with positive scan results who had not previously received those drugs, and the use of the drugs was discontinued in 6 (33.3{\%}) patients with negative scan results who were receiving those drugs (P < .001). CONCLUSIONS AND RELEVANCE Amyloid PET in addition to routine assessment in patients with cognitive impairment has a significant effect on diagnosis, diagnostic confidence, and drug treatment. The effect on health outcomes, such as morbidity and mortality, remains to be assessed.",
author = "Marina Boccardi and Daniele Altomare and Clarissa Ferrari and Cristina Festari and Guerra, {Ugo Paolo} and Barbara Paghera and Claudio Pizzocaro and Giulia Lussignoli and Cristina Geroldi and Orazio Zanetti and Cotelli, {Maria Sofia} and Marinella Turla and Barbara Borroni and Luca Rozzini and Dario Mirabile and Carlo Defanti and Michele Gennuso and Alessandro Prelle and Simona Gentile and Alessandro Morandi and Stefano Vollaro and Volta, {Giorgio Dalla} and Angelo Bianchetti and Conti, {Marta Zaffira} and Melania Cappuccio and Pasqualina Carbone and Daniele Bellandi and Luciano Abruzzi and Luigi Bettoni and Daniele Villani and Raimondi, {Maria Clara} and Alessia Lanari and Alfonso Ciccone and Emanuela Facchi and {Di Fazio}, Ignazio and Renzo Rozzini and Stefano Boffelli and Laura Manzoni and Salvi, {Giovanni Pietro} and Sabina Cavaliere and Gloria Belotti and Stefano Avanzi and Patrizio Pasqualetti and Cristina Muscio and Alessandro Padovani and Frisoni, {Giovanni B.} and Luigi Antelmi and Samantha Galluzzi and Michela Pievani and Alberto Redolfi and Anna Tarallo and Anupa Arora and Monica Bertocchi and Eugenia Chit{\`o} and Moretti, {Davide V.} and Raffaele Giubbini and Carlo Rodella and Luca Camoni and Valentina Massetti and Michela Andreoli and Giuseppe Bellelli and Sara Fascendini and Flavia Mattioli and Renato Turco and Giuliana Vezzadini and Vanessa Raimondi and Sara Mondini and Zanacchi, {Elisa Carolina} and Marta Grigolo and Alessandra Pezzini and Giacinta Bilotti and Barbara Bigni and Paola Zavarise and Gael Ngonga and Anzola, {Gian Paolo} and Rosanna Turrone and Gianluca Guizzetti and Marina Zanetti",
year = "2016",
doi = "10.1001/jamaneurol.2016.3751",
language = "English",
volume = "73",
pages = "1417--1424",
journal = "JAMA Neurology",
issn = "2168-6149",
publisher = "American Medical Association",
number = "12",

}

TY - JOUR

T1 - Assessment of the incremental diagnostic value of florbetapir F 18 imaging in patients with cognitive impairment

T2 - JAMA Neurology

AU - Boccardi,Marina

AU - Altomare,Daniele

AU - Ferrari,Clarissa

AU - Festari,Cristina

AU - Guerra,Ugo Paolo

AU - Paghera,Barbara

AU - Pizzocaro,Claudio

AU - Lussignoli,Giulia

AU - Geroldi,Cristina

AU - Zanetti,Orazio

AU - Cotelli,Maria Sofia

AU - Turla,Marinella

AU - Borroni,Barbara

AU - Rozzini,Luca

AU - Mirabile,Dario

AU - Defanti,Carlo

AU - Gennuso,Michele

AU - Prelle,Alessandro

AU - Gentile,Simona

AU - Morandi,Alessandro

AU - Vollaro,Stefano

AU - Volta,Giorgio Dalla

AU - Bianchetti,Angelo

AU - Conti,Marta Zaffira

AU - Cappuccio,Melania

AU - Carbone,Pasqualina

AU - Bellandi,Daniele

AU - Abruzzi,Luciano

AU - Bettoni,Luigi

AU - Villani,Daniele

AU - Raimondi,Maria Clara

AU - Lanari,Alessia

AU - Ciccone,Alfonso

AU - Facchi,Emanuela

AU - Di Fazio,Ignazio

AU - Rozzini,Renzo

AU - Boffelli,Stefano

AU - Manzoni,Laura

AU - Salvi,Giovanni Pietro

AU - Cavaliere,Sabina

AU - Belotti,Gloria

AU - Avanzi,Stefano

AU - Pasqualetti,Patrizio

AU - Muscio,Cristina

AU - Padovani,Alessandro

AU - Frisoni,Giovanni B.

AU - Antelmi,Luigi

AU - Galluzzi,Samantha

AU - Pievani,Michela

AU - Redolfi,Alberto

AU - Tarallo,Anna

AU - Arora,Anupa

AU - Bertocchi,Monica

AU - Chitò,Eugenia

AU - Moretti,Davide V.

AU - Giubbini,Raffaele

AU - Rodella,Carlo

AU - Camoni,Luca

AU - Massetti,Valentina

AU - Andreoli,Michela

AU - Bellelli,Giuseppe

AU - Fascendini,Sara

AU - Mattioli,Flavia

AU - Turco,Renato

AU - Vezzadini,Giuliana

AU - Raimondi,Vanessa

AU - Mondini,Sara

AU - Zanacchi,Elisa Carolina

AU - Grigolo,Marta

AU - Pezzini,Alessandra

AU - Bilotti,Giacinta

AU - Bigni,Barbara

AU - Zavarise,Paola

AU - Ngonga,Gael

AU - Anzola,Gian Paolo

AU - Turrone,Rosanna

AU - Guizzetti,Gianluca

AU - Zanetti,Marina

PY - 2016

Y1 - 2016

N2 - IMPORTANCE Cerebral amyloidosis is a key abnormality in Alzheimer disease (AD) and can be detected in vivo with positron emission tomography (PET) ligands. Although amyloid PET has clearly demonstrated analytical validity, its clinical utility is debated. OBJECTIVE To evaluate the incremental diagnostic value of amyloid PET with florbetapir F 18 in addition to the routine clinical diagnostic assessment of patients evaluated for cognitive impairment. DESIGN, SETTING, AND PARTICIPANTS The Incremental Diagnostic Value ofAmyloid PET With [18F]-Florbetapir (INDIA-FBP) Study is a multicenter study involving 18 AD evaluation units from eastern Lombardy, Northern Italy, 228 consecutive adults with cognitive impairmentwere evaluated for AD and other causes of cognitive decline, with a prescan diagnostic confidence of AD between 15%and 85%. Participants underwent routine clinical and instrumental diagnostic assessment. A prescan diagnosiswas made, diagnostic confidencewas estimated, and drug treatmentwas provided. At the time of thisworkup, an amyloid PET/computed tomographic scanwas performed, and the resultwas communicated to physicians afterworkup completion. Physicianswere asked to review the diagnosis, diagnostic confidence, and treatment after the scan. The studywas conducted from August 5, 2013, to December 31, 2014. MAIN OUTCOMES AND MEASURES Primary outcomeswere prescan to postscan changes of diagnosis, diagnostic confidence, and treatment. RESULTS Of the 228 participants, 107 (46%) were male; mean (SD) age was 70.5 (7) years. Diagnostic change occurred in 46 patients (79%) having both a previous diagnosis of AD and an amyloid-negative scan (P < .001) and in 16 (53%) of those with non-AD diagnoses and an amyloid-positive scan (P < .001). Diagnostic confidence in AD diagnosis increased by 15.2%in amyloid-positive (P < .001; effect size Cohen d = 1.04) and decreased by 29.9%in amyloid-negative (P < .001; d = -1.19) scans. Acetylcholinesterase inhibitors and memantine hydrochloride were introduced in 61 (65.6%) patients with positive scan results who had not previously received those drugs, and the use of the drugs was discontinued in 6 (33.3%) patients with negative scan results who were receiving those drugs (P < .001). CONCLUSIONS AND RELEVANCE Amyloid PET in addition to routine assessment in patients with cognitive impairment has a significant effect on diagnosis, diagnostic confidence, and drug treatment. The effect on health outcomes, such as morbidity and mortality, remains to be assessed.

AB - IMPORTANCE Cerebral amyloidosis is a key abnormality in Alzheimer disease (AD) and can be detected in vivo with positron emission tomography (PET) ligands. Although amyloid PET has clearly demonstrated analytical validity, its clinical utility is debated. OBJECTIVE To evaluate the incremental diagnostic value of amyloid PET with florbetapir F 18 in addition to the routine clinical diagnostic assessment of patients evaluated for cognitive impairment. DESIGN, SETTING, AND PARTICIPANTS The Incremental Diagnostic Value ofAmyloid PET With [18F]-Florbetapir (INDIA-FBP) Study is a multicenter study involving 18 AD evaluation units from eastern Lombardy, Northern Italy, 228 consecutive adults with cognitive impairmentwere evaluated for AD and other causes of cognitive decline, with a prescan diagnostic confidence of AD between 15%and 85%. Participants underwent routine clinical and instrumental diagnostic assessment. A prescan diagnosiswas made, diagnostic confidencewas estimated, and drug treatmentwas provided. At the time of thisworkup, an amyloid PET/computed tomographic scanwas performed, and the resultwas communicated to physicians afterworkup completion. Physicianswere asked to review the diagnosis, diagnostic confidence, and treatment after the scan. The studywas conducted from August 5, 2013, to December 31, 2014. MAIN OUTCOMES AND MEASURES Primary outcomeswere prescan to postscan changes of diagnosis, diagnostic confidence, and treatment. RESULTS Of the 228 participants, 107 (46%) were male; mean (SD) age was 70.5 (7) years. Diagnostic change occurred in 46 patients (79%) having both a previous diagnosis of AD and an amyloid-negative scan (P < .001) and in 16 (53%) of those with non-AD diagnoses and an amyloid-positive scan (P < .001). Diagnostic confidence in AD diagnosis increased by 15.2%in amyloid-positive (P < .001; effect size Cohen d = 1.04) and decreased by 29.9%in amyloid-negative (P < .001; d = -1.19) scans. Acetylcholinesterase inhibitors and memantine hydrochloride were introduced in 61 (65.6%) patients with positive scan results who had not previously received those drugs, and the use of the drugs was discontinued in 6 (33.3%) patients with negative scan results who were receiving those drugs (P < .001). CONCLUSIONS AND RELEVANCE Amyloid PET in addition to routine assessment in patients with cognitive impairment has a significant effect on diagnosis, diagnostic confidence, and drug treatment. The effect on health outcomes, such as morbidity and mortality, remains to be assessed.

UR - http://www.scopus.com/inward/record.url?scp=85011556754&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85011556754&partnerID=8YFLogxK

U2 - 10.1001/jamaneurol.2016.3751

DO - 10.1001/jamaneurol.2016.3751

M3 - Article

VL - 73

SP - 1417

EP - 1424

JO - JAMA Neurology

JF - JAMA Neurology

SN - 2168-6149

IS - 12

ER -