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.

 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%).