Racial and Ethnic Differences in Amyloid PET Positivity in Individuals With Mild Cognitive Impairment or Dementia : A Secondary Analysis of the Imaging Dementia–Evidence for Amyloid Scanning (IDEAS) Cohort Study

Key Points

Question

Do amyloid positron emission tomography (PET) positivity rates differ across racial and ethnic groups with mild cognitive impairment (MCI) or dementia?

Findings

In this cohort study of 17 107 Medicare beneficiaries with MCI or dementia, the proportion of amyloid positive PET scans was greater among White participants compared with Black and Asian participants. When racial and ethnic groups were matched by social and demographic factors, the proportion of amyloid positive PET scans was greater among White participants compared with Hispanic and Asian participants but not compared with Black participants.

Meaning

The results of this study showed differences in rates of amyloid PET positivity among racial and ethnic groups; these findings may reflect differences in underlying etiology of cognitive impairment between groups.

Abstract

This cohort study evaluates differences by race and ethnicity in participants with mild cognitive impairment or dementia.

Abstract

Importance

Racial and ethnic groups with higher rates of clinical Alzheimer disease (AD) are underrepresented in studies of AD biomarkers, including amyloid positron emission tomography (PET).

Objective

To compare amyloid PET positivity among a diverse cohort of individuals with mild cognitive impairment (MCI) or dementia.

Design, Setting, and Participants

Secondary analysis of the Imaging Dementia–Evidence for Amyloid Scanning (IDEAS), a single-arm multisite cohort study of Medicare beneficiaries who met appropriate-use criteria for amyloid PET imaging between February 2016 and September 2017 with follow-up through January 2018. Data were analyzed between April 2020 and January 2022. This study used 2 approaches: the McNemar test to compare amyloid PET positivity proportions between matched racial and ethnic groups and multivariable logistic regression to assess the odds of having a positive amyloid PET scan. IDEAS enrolled participants at 595 US dementia specialist practices. A total of 21 949 were enrolled and 4842 (22%) were excluded from the present analysis due to protocol violations, not receiving an amyloid PET scan, not having a positive or negative scan, or because of small numbers in some subgroups.

Exposures

In the IDEAS study, participants underwent a single amyloid PET scan.

Main Outcomes and Measures

The main outcomes were amyloid PET positivity proportions and odds.

Results

Data from 17 107 individuals (321 Asian, 635 Black, 829 Hispanic, and 15 322 White) with MCI or dementia and amyloid PET were analyzed between April 2020 and January 2022. The median (range) age of participants was 75 (65-105) years; 8769 participants (51.3%) were female and 8338 (48.7%) were male. In the optimal 1:1 matching analysis (n = 3154), White participants had a greater proportion of positive amyloid PET scans compared with Asian participants (181 of 313; 57.8%; 95% CI, 52.3-63.2 vs 142 of 313; 45.4%; 95% CI, 39.9-50.9, respectively; P = .001) and Hispanic participants (482 of 780; 61.8%; 95% CI, 58.3-65.1 vs 425 of 780; 54.5%; 95% CI, 51.0-58.0, respectively; P = .003) but not Black participants (359 of 615; 58.4%; 95% CI, 54.4-62.2 vs 333 of 615; 54.1%; 95% CI, 50.2-58.0, respectively; P = .13). In the adjusted model, the odds of having a positive amyloid PET scan were lower for Asian participants (odds ratio [OR], 0.47; 95% CI, 0.37-0.59; P < .001), Black participants (OR, 0.71; 95% CI, 0.60-0.84; P < .001), and Hispanic participants (OR, 0.68; 95% CI, 0.59-0.79; P < .001) compared with White participants.

Conclusions and Relevance

Racial and ethnic differences found in amyloid PET positivity among individuals with MCI and dementia in this study may indicate differences in underlying etiology of cognitive impairment and guide future treatment and prevention approaches.