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Liu F, Shi Y, Wu Q, Chen H, Wang Y, Cai L, Zhang N. The value of FDG combined with PiB PET in the diagnosis of patients with cognitive impairment in a memory clinic. CNS Neurosci Ther 2024; 30:e14418. [PMID: 37602885 PMCID: PMC10848040 DOI: 10.1111/cns.14418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/12/2023] [Accepted: 08/07/2023] [Indexed: 08/22/2023] Open
Abstract
AIMS To analyze the value of 18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET) combined with amyloid PET in cognitive impairment diagnosis. METHODS A total of 187 patients with dementia or mild cognitive impairment (MCI) who underwent 11 C-Pittsburgh compound B (PiB) and FDG PET scans in a memory clinic were included in the final analysis. RESULTS Amyloid-positive and amyloid-negative dementia patient groups showed a significant difference in the proportion of individuals presenting temporoparietal cortex (p < 0.001) and posterior cingulate/precuneus cortex (p < 0.001) hypometabolism. The sensitivity and specificity of this hypometabolic pattern for identifying amyloid pathology were 72.61% and 77.97%, respectively, in patients clinically diagnosed with AD and 60.87% and 76.19%, respectively, in patients with MCI. The initial diagnosis was changed in 32.17% of patients with dementia after considering both PiB and FDG results. There was a significant difference in both the proportion of patients showing the hypometabolic pattern and PiB positivity between dementia conversion patients and patients with a stable diagnosis of MCI (p < 0.05). CONCLUSION Temporoparietal and posterior cingulate/precuneus cortex hypometabolism on FDG PET suggested amyloid pathology in patients with cognitive impairment and is helpful in diagnostic decision-making and predicting AD dementia conversion from MCI, particularly when combined with amyloid PET.
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Affiliation(s)
- Fang Liu
- Department of NeurologyTianjin Neurological Institute, Tianjin Medical University General HospitalTianjinChina
| | - Yudi Shi
- Department of NeurologyTianjin Neurological Institute, Tianjin Medical University General HospitalTianjinChina
- Health Management CenterTianjin Medical University General Hospital Airport SiteTianjinChina
| | - Qiuyan Wu
- Department of NeurologyTianjin Neurological Institute, Tianjin Medical University General HospitalTianjinChina
| | - Huifeng Chen
- Department of NeurologyTianjin Neurological Institute, Tianjin Medical University General HospitalTianjinChina
- Department of NeurologyTianjin Medical University General Hospital Airport SiteTianjinChina
| | - Ying Wang
- PET/CT CenterTianjin Medical University General HospitalTianjinChina
| | - Li Cai
- PET/CT CenterTianjin Medical University General HospitalTianjinChina
| | - Nan Zhang
- Department of NeurologyTianjin Neurological Institute, Tianjin Medical University General HospitalTianjinChina
- Department of NeurologyTianjin Medical University General Hospital Airport SiteTianjinChina
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An SK, Jang H, Kim HJ, Na DL, Yoon JH. Linguistic, visuospatial, and kinematic writing characteristics in cognitively impaired patients with beta-amyloid deposition. Front Aging Neurosci 2023; 15:1217746. [PMID: 37753065 PMCID: PMC10518411 DOI: 10.3389/fnagi.2023.1217746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/26/2023] [Indexed: 09/28/2023] Open
Abstract
Introduction Beta-amyloid (Aβ) deposition, a hallmark of Alzheimer's disease (AD), begins before dementia and is an important factor in mild cognitive impairment (MCI). Aβ deposition is a recognized risk factor for various cognitive impairments and has been reported to affect motor performance as well. This study aimed to identify the linguistic, visuospatial, and kinematic characteristics evident in the writing performance of patients with cognitive impairment (CI) who exhibit Aβ deposition. Methods A total of 31 patients diagnosed with amnestic mild cognitive impairment (aMCI) with Aβ deposition, 26 patients with Alzheimer's-type dementia, and 33 healthy control (HC) participants without deposition were administered tasks involving dictation of 60 regular words, irregular words, and non-words consisting of 1-4 syllables. Responses from all participants were collected and analyzed through digitized writing tests and analysis tools. Results In terms of linguistic aspects, as cognitive decline progressed, performance in the dictation of irregular words decreased, with errors observed in substituting the target grapheme with other graphemes. The aMCI group frequently exhibited corrective aspects involving letter rewriting during the task. In terms of visuospatial aspects, the AD group displayed more errors in grapheme combination compared to the HC group. Lastly, in the kinematic aspects, both the aMCI group and the AD group exhibited slower writing speeds compared to the HC group. Discussion The findings suggest that individuals in the CI group exhibited lower performance in word dictation tasks than those in the HC group, and these results possibly indicate complex cognitive-language-motor deficits resulting from temporal-parietal lobe damage, particularly affecting spelling processing. These results provide valuable clinical insights into understanding linguistic-visuospatial-kinematic aspects that contribute to the early diagnosis of CI with Aβ deposition.
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Affiliation(s)
- Seo Kyung An
- Department of Speech-Language Pathology and Audiology, Hallym University, Chuncheon, Republic of Korea
| | - Hyemin Jang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Duk L. Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Hye Yoon
- Division of Speech Pathology and Audiology, Research Institute of Audiology and Speech Pathology, Hallym University, Chuncheon, Republic of Korea
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3
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Bakker ED, van der Pas SL, Zwan MD, Gillissen F, Bouwman FH, Scheltens P, van der Flier WM, van Maurik IS. Steeper memory decline after COVID-19 lockdown measures. Alzheimers Res Ther 2023; 15:81. [PMID: 37061745 PMCID: PMC10104769 DOI: 10.1186/s13195-023-01226-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 04/05/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND During COVID-19 lockdown measures, memory clinic patients reported worries for faster cognitive decline, due to loss of structure and feelings of loneliness and depression. We aimed to investigate the impact of the COVID-19 lockdown on rate of cognitive decline in a mixed memory clinic population, compared to matched historical controls. METHODS We included patients who visited Alzheimer Center Amsterdam 6 months to 1 week before the first Dutch COVID-19 lockdown, and had a second visit 1 year later, after this lockdown period (n = 113; 66 ± 7 years old; 30% female; n = 55 dementia, n = 31 mild cognitive impairment (MCI), n = 18 subjective cognitive decline (SCD), n = 9 postponed diagnosis). Historical controls (visit in 2016/2017 and second visit 1 year later (n = 640)) were matched 1:1 to lockdown patients by optimal Mahalanobis distance matching (both groups n = 113). Groups were well matched. Differences between lockdown patients and historical controls over time in Mini-Mental State Examination, Trail Making Test part A and B, Rey-Auditory Verbal Learning Test (RAVLT) immediate and delayed recall, and category fluency scores were analyzed using linear mixed effect models with random intercepts. We examined differences in rate of cognitive decline between whole groups, and after stratification in SCD, MCI, and dementia separately. RESULTS Lockdown patients had a faster rate of memory decline compared to controls on both RAVLT immediate [B(SE) = - 2.62 (1.07), p = 0.015] and delayed recall [B(SE) = - 1.07 (0.34), p = 0.002]. Stratification by syndrome diagnosis showed that this effect was largely attributable to non-demented participants, as we observed faster memory decline during lockdown in SCD and MCI (RAVLT immediate [SCD: B(SE) = - 6.85 (2.97), p = 0.027; MCI: B(SE) = - 6.14 (1.78), p = 0.001] and delayed recall [SCD: B(SE) = - 2.45 (1.11), p = 0.035; MCI: B(SE) = - 1.50 (0.51), p = 0.005]), but not in dementia. CONCLUSION Memory clinic patients, specifically in pre-dementia stages, showed faster memory decline during COVID-19 lockdown, providing evidence that lockdown regulations had a deleterious effect on brain health. In individuals that may have been able to deal with accumulating, subclinical neuropathology under normal and structured circumstances, the additional stress of lockdown regulations may have acted as a "second hit," resulting in less beneficial disease trajectory.
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Affiliation(s)
- Els D Bakker
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, De Boelelaan 1118, Amsterdam, The Netherlands.
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands.
| | - Stéphanie L van der Pas
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
| | - Marissa D Zwan
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, De Boelelaan 1118, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Freek Gillissen
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, De Boelelaan 1118, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Femke H Bouwman
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, De Boelelaan 1118, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, De Boelelaan 1118, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, De Boelelaan 1118, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
| | - Ingrid S van Maurik
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, De Boelelaan 1118, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
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4
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Tomadesso C, de Lizarrondo SM, Ali C, Landeau B, Mézenge F, Perrotin A, de La Sayette V, Vivien D, Chételat G. Plasma Levels of Tissue-Type Plasminogen Activator (tPA) in Normal Aging and Alzheimer's Disease: Links With Cognition, Brain Structure, Brain Function and Amyloid Burden. Front Aging Neurosci 2022; 14:871214. [PMID: 35747448 PMCID: PMC9211060 DOI: 10.3389/fnagi.2022.871214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
Tissue-type plasminogen activator (tPA) is a protease known for its fibrinolytic action but is also involved in physiological and pathophysiological aging processes; including amyloid elimination and synaptic plasticity. The aim of the study was to investigate the role of tPA in cognitive and brain aging. Therefore, we assessed the links between tPA plasma concentration and cognition, structural MRI, FDG-PET and Flobetapir-PET neuroimaging in 155 cognitively unimpaired adults (CUA, aged 20-85 years old) and 32 patients with Alzheimer's disease (ALZ). A positive correlation was found between tPA and age in CUA (p < 0.001), with males showing higher tPA than females (p = 0.05). No significant difference was found between ALZ patients and cognitively unimpaired elders (CUE). Plasma tPA in CUA negatively correlated with global brain volume. No correlation was found with brain FDG metabolism or amyloid deposition. Age-related tPA changes were associated to changes in blood pressure, glycemia and body mass index. Within the ALZ patients, tPA didn't correlate with any cognitive or neuroimaging measures, but only with physiological measures. Altogether our study suggests that increased tPA plasma concentration with age is related to neuronal alterations and cardiovascular risk factors.
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Affiliation(s)
- Clémence Tomadesso
- Normandie Univ, UNICAEN, INSERM, UMR-S U1237, PHIND, Blood and Brain @ Caen Normandy Institute, Caen, France
- Department of Clinical Research, CHU Caen-Normandie, Caen, France
| | - Sara Martinez de Lizarrondo
- Normandie Univ, UNICAEN, INSERM, UMR-S U1237, PHIND, Blood and Brain @ Caen Normandy Institute, Caen, France
| | - Carine Ali
- Normandie Univ, UNICAEN, INSERM, UMR-S U1237, PHIND, Blood and Brain @ Caen Normandy Institute, Caen, France
| | - Brigitte Landeau
- Normandie Univ, UNICAEN, INSERM, UMR-S U1237, PHIND, Blood and Brain @ Caen Normandy Institute, Caen, France
| | - Florence Mézenge
- Normandie Univ, UNICAEN, INSERM, UMR-S U1237, PHIND, Blood and Brain @ Caen Normandy Institute, Caen, France
| | - Audrey Perrotin
- Normandie Univ, UNICAEN, INSERM, UMR-S U1237, PHIND, Blood and Brain @ Caen Normandy Institute, Caen, France
| | - Vincent de La Sayette
- Normandie Univ, UNICAEN, INSERM, UMR-S U1237, PHIND, Blood and Brain @ Caen Normandy Institute, Caen, France
| | - Denis Vivien
- Normandie Univ, UNICAEN, INSERM, UMR-S U1237, PHIND, Blood and Brain @ Caen Normandy Institute, Caen, France
- Department of Clinical Research, CHU Caen-Normandie, Caen, France
| | - Gaël Chételat
- Normandie Univ, UNICAEN, INSERM, UMR-S U1237, PHIND, Blood and Brain @ Caen Normandy Institute, Caen, France
- *Correspondence: Gaël Chételat
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Relationships between diabetes-related vascular risk factors and neurodegeneration biomarkers in healthy aging and Alzheimer's disease. Neurobiol Aging 2022; 118:25-33. [DOI: 10.1016/j.neurobiolaging.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 04/15/2022] [Accepted: 06/17/2022] [Indexed: 11/20/2022]
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6
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Ho SH, Yang DW. Risk Factors Predicting Amyloid PET Positivity in Patients with Mild Cognitive Impairment and Apolipoprotein E ɛ3/ɛ3 Genotypes. J Alzheimers Dis 2021; 77:1017-1024. [PMID: 32804143 DOI: 10.3233/jad-200439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The apolipoprotein E (APOE) ɛ4 allele is a well-known risk factor for AD and is associated with higher amyloid deposition and earlier dementia onset. However, the relationship between amyloid pathology and the most common APOE allele, ɛ3, has not been well studied. OBJECTIVE In this study, we aimed to identify the risk factors predicting amyloid PET positivity in patients with mild cognitive impairment (MCI) and APOEɛ3/ɛ3 genotypes. METHODS We retrospectively reviewed the medical records of MCI patients with APOEɛ3/ɛ3 genotypes who underwent amyloid PET scanning. Demographics, neuropsychological tests, and brain MRI were obtained. We analyzed which risk factors could affect amyloid PET positivity in MCI patients with APOEɛ3/ɛ3 genotypes using logistic regression models. RESULTS We recruited 171 MCI patients with APOEɛ3/ɛ3 genotypes in this study. Out of 171 patients, 49 patients (28.65%) showed positive results in the amyloid PET scans. In a multivariate logistic regression model, amyloid positivity was associated with frontal atrophy (OR = 2.63, p = 0.009), and CDR-SOB scores (OR = 2.46, p = 0.013). The odds ratio for amyloid PET positivity in patients older than and equal to 75 years with both frontal atrophy and CDR-SOB scores >1.0 was 3.63. CONCLUSION Our study demonstrated that frontal atrophy, high CDR-SOB scores, and old age were risk factors associated with amyloid PET positivity in MCI with APOEɛ3/ɛ3 genotypes.
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Affiliation(s)
- Seong Hee Ho
- Department of Neurology, The Catholic University of Korea Seoul St. Mary's hospital, Seoul, Republic of Korea
| | - Dong-Won Yang
- Department of Neurology, The Catholic University of Korea Seoul St. Mary's hospital, Seoul, Republic of Korea
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7
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Tsoy E, Strom A, Iaccarino L, Erlhoff SJ, Goode CA, Rodriguez AM, Rabinovici GD, Miller BL, Kramer JH, Rankin KP, La Joie R, Possin KL. Detecting Alzheimer's disease biomarkers with a brief tablet-based cognitive battery: sensitivity to Aβ and tau PET. ALZHEIMERS RESEARCH & THERAPY 2021; 13:36. [PMID: 33557905 PMCID: PMC7871372 DOI: 10.1186/s13195-021-00776-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/25/2021] [Indexed: 11/29/2022]
Abstract
Background β-amyloid (Aβ) and tau positron emission tomography (PET) detect the pathological changes that define Alzheimer’s disease (AD) in living people. Cognitive measures sensitive to Aβ and tau burden may help streamline identification of cases for confirmatory AD biomarker testing. Methods We examined the association of Brain Health Assessment (BHA) tablet-based cognitive measures with dichotomized Aβ -PET status using logistic regression models in individuals with mild cognitive impairment (MCI) or dementia (N = 140; 43 Aβ-, 97 Aβ+). We also investigated the relationship between the BHA tests and regional patterns of tau-PET signal using voxel-wise regression analyses in a subsample of 60 Aβ+ individuals with MCI or dementia. Results Favorites (associative memory), Match (executive functions and speed), and Everyday Cognition Scale scores were significantly associated with Aβ positivity (area under the curve [AUC] = 0.75 [95% CI 0.66–0.85]). We found significant associations with tau-PET signal in mesial temporal regions for Favorites, frontoparietal regions for Match, and occipitoparietal regions for Line Orientation (visuospatial skills) in a subsample of individuals with MCI and dementia. Conclusion The BHA measures are significantly associated with both Aβ and regional tau in vivo imaging markers and could be used for the identification of patients with suspected AD pathology in clinical practice. Supplementary Information The online version contains supplementary material available at 10.1186/s13195-021-00776-w.
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Affiliation(s)
- Elena Tsoy
- Department of Neurology, Memory and Aging Center, University of California San Francisco, Box 1207, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Amelia Strom
- Department of Neurology, Memory and Aging Center, University of California San Francisco, Box 1207, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Leonardo Iaccarino
- Department of Neurology, Memory and Aging Center, University of California San Francisco, Box 1207, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Sabrina J Erlhoff
- Department of Neurology, Memory and Aging Center, University of California San Francisco, Box 1207, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Collette A Goode
- Department of Neurology, Memory and Aging Center, University of California San Francisco, Box 1207, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Anne-Marie Rodriguez
- Department of Neurology, Memory and Aging Center, University of California San Francisco, Box 1207, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Gil D Rabinovici
- Department of Neurology, Memory and Aging Center, University of California San Francisco, Box 1207, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA.,Department of Radiology and Biomedical Imaging, University of California San Francisco, 1500 Owens Street, 2nd Fl, San Francisco, CA, 94158, USA
| | - Bruce L Miller
- Department of Neurology, Memory and Aging Center, University of California San Francisco, Box 1207, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA.,Global Brain Health Institute, University of California San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Joel H Kramer
- Department of Neurology, Memory and Aging Center, University of California San Francisco, Box 1207, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA.,Global Brain Health Institute, University of California San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Katherine P Rankin
- Department of Neurology, Memory and Aging Center, University of California San Francisco, Box 1207, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Renaud La Joie
- Department of Neurology, Memory and Aging Center, University of California San Francisco, Box 1207, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Katherine L Possin
- Department of Neurology, Memory and Aging Center, University of California San Francisco, Box 1207, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA. .,Global Brain Health Institute, University of California San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA.
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8
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Loreto F, Gunning S, Golemme M, Watt H, Patel N, Win Z, Carswell C, Perry RJ, Malhotra PA. Evaluating cognitive profiles of patients undergoing clinical amyloid-PET imaging. Brain Commun 2021; 3:fcab035. [PMID: 34222867 PMCID: PMC8244634 DOI: 10.1093/braincomms/fcab035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/06/2021] [Accepted: 01/25/2021] [Indexed: 11/13/2022] Open
Abstract
Episodic memory impairment and brain amyloid-beta are two of the main hallmarks of Alzheimer's Disease. In the clinical setting, these are often evaluated through neuropsychological testing and amyloid PET imaging, respectively. The use of amyloid PET in clinical practice is only indicated in patients with substantial diagnostic uncertainty due to atypical clinical presentation, multiple comorbidities and/or early age of onset. The relationship between amyloid-beta and cognition has been previously investigated, but no study has examined how neuropsychological features relate to the presence of amyloid pathology in the clinical population that meets the appropriate use criteria for amyloid PET imaging. In this study, we evaluated a clinical cohort of patients (n = 107) who presented at the Imperial Memory Clinic and were referred for clinical amyloid PET and neuropsychological assessment as part of their diagnostic workup. We compared the cognitive performance of amyloid-positive patients (Aβ-pos, n = 47) with that of stable amyloid-negative (stableAβ-neg, n = 26) and progressive amyloid-negative (progAβ-neg, n = 34) patients. The amyloid-positive group performed significantly worse than both amyloid-negative groups in the visuospatial and working memory domains. Episodic memory performance, however, effectively differentiated the amyloid-positive group from the stable but not the progressive amyloid-negative group. On affective questionnaires, the stable amyloid-negative group reported significantly higher levels of depression than the amyloid-positive group. In our clinical cohort, visuospatial dysfunction and working memory impairment were better indicators of amyloid positivity than episodic memory dysfunction. These findings highlight the limited value of isolated cognitive scores in patients with atypical clinical presentation, comorbidities and/or early age of onset.
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Affiliation(s)
- Flavia Loreto
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London W6 8RP, UK
| | - Stephen Gunning
- Department of Neuropsychology, Imperial College Healthcare NHS Trust, London W6 8RF, UK
| | - Mara Golemme
- Department of Neurology, Imperial College Healthcare NHS Trust, London W6 8RF, UK
| | - Hilary Watt
- Department of Primary Care and Public Health, Faculty of Medicine, Imperial College London, London W6 8RP, UK
| | - Neva Patel
- Department of Nuclear Medicine, Imperial College Healthcare NHS Trust, London W6 8RF, UK
| | - Zarni Win
- Department of Nuclear Medicine, Imperial College Healthcare NHS Trust, London W6 8RF, UK
| | - Christopher Carswell
- Department of Neurology, Imperial College Healthcare NHS Trust, London W6 8RF, UK
| | - Richard J Perry
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London W6 8RP, UK
| | - Paresh A Malhotra
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London W6 8RP, UK
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9
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Alves L, Cardoso S, Silva D, Mendes T, Marôco J, Nogueira J, Lima M, Tábuas-Pereira M, Baldeiras I, Santana I, de Mendonça A, Guerreiro M. Neuropsychological profile of amyloid-positive versus amyloid-negative amnestic Mild Cognitive Impairment. J Neuropsychol 2020; 15 Suppl 1:41-52. [PMID: 32588984 DOI: 10.1111/jnp.12218] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/19/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Patients diagnosed with amnestic mild cognitive impairment (aMCI) are at high risk of progressing to dementia. It became possible, through the use of biomarkers, to diagnose those patients with aMCI who have Alzheimer's disease. However, it is presently unfeasible that all patients undergo biomarker testing. Since neuropsychological testing is required to make a formal diagnosis of aMCI, it would be interesting if it could be used to predict the amyloid status of patients with aMCI. METHODS Participants with aMCI, known amyloid status (Aβ+ or Aβ-) and a comprehensive neuropsychological evaluation, were selected from the Cognitive Complaints Cohort database for this study. Neuropsychological tests were compared in Aβ+ and Aβ- aMCI patients. A binary logistic regression analysis was conducted to model the probability of being amyloid positive. RESULTS Of the 216 aMCI patients studied, 117 were Aβ+ and 99 were Aβ-. Aβ+ aMCI patients performed worse on several memory tests, namely Word Total Recall, Logical Memory Immediate and Delayed Free Recall, and Verbal Paired Associate Learning, as well as on Trail Making Test B, an executive function test. In a binary logistic regression model, only Logical Memory Delayed Free Recall retained significance, so that for each additional score point in this test, the probability of being amyloid positive decreased by 30.6%. The resulting model correctly classified 64.6% of the aMCI cases regarding their amyloid status. CONCLUSIONS The neuropsychological assessment remains an essential step to diagnose and characterize patients with aMCI; however, neuropsychological tests have limited value to distinguish the aMCI patients who have amyloid pathology from those who might suffer from other clinical conditions.
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Affiliation(s)
- Luísa Alves
- Chronic Diseases Research Centre, NOVA Medical School, NOVA University of Lisbon, Portugal
| | | | - Dina Silva
- Faculty of Medicine, University of Lisbon, Portugal.,Cognitive Neuroscience Research Group, Department of Psychology and Educational Sciences and Center for Biomedical Research (CBMR), Universidade do Algarve, Faro, Portugal
| | - Tiago Mendes
- Faculty of Medicine, University of Lisbon, Portugal.,Psychiatry and Mental Health Department, Santa Maria Hospital, Lisbon, Portugal
| | - João Marôco
- Instituto Superior de Psicologia Aplicada, Lisbon, Portugal
| | - Joana Nogueira
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Portugal.,Faculdade de Medicina da Universidade de Coimbra, Portugal
| | - Marisa Lima
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Portugal.,Faculdade de Medicina da Universidade de Coimbra, Portugal
| | - Miguel Tábuas-Pereira
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Portugal.,Faculdade de Medicina da Universidade de Coimbra, Portugal
| | - Inês Baldeiras
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Portugal.,Faculdade de Medicina da Universidade de Coimbra, Portugal
| | - Isabel Santana
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Portugal.,Faculdade de Medicina da Universidade de Coimbra, Portugal
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Shi Z, Fu LP, Zhang N, Zhao X, Liu S, Zuo C, Cai L, Wang Y, Gao S, Ai L, Guan YH, Xu B, Ji Y. Amyloid PET in Dementia Syndromes: A Chinese Multicenter Study. J Nucl Med 2020; 61:1814-1819. [PMID: 32385166 DOI: 10.2967/jnumed.119.240325] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/28/2020] [Indexed: 12/15/2022] Open
Abstract
Cerebral β-amyloid deposits and regional glucose metabolism assessed by PET are used to distinguish between Alzheimer disease (AD) and other dementia syndromes. In the present multicenter study, we estimated the prevalence of β-amyloid deposits on PET imaging in a wide variety of dementia syndromes and mild cognitive impairment (MCI) within a memory clinic population. Methods: Of the 1,193 consecutive patients with cognitive impairment (CI) who received 1 11C-PIB PET or 18F-AV45 PET or both 11C-PIB PET and 18F-AV45 PET, 960 were diagnosed with AD, 36 with frontotemporal dementia (FTD), 5 with dementia with Lewy bodies, 144 with MCI, 29 with vascular dementia, 4 with corticobasal syndrome, and 15 with unclassifiable dementia. Baseline clinical diagnoses were independently established without access to PET imaging results. Apolipoprotein E (ApoE) genotype analysis was performed on CI patients and 231 sex- and age-matched controls. Results: Of the 1,193 CI patients, 860 (72.1%) were amyloid-positive. The prevalence of amyloid positivity in AD and MCI patients was 86.8% (833/960) and 9.7% (14/144), respectively. In FTD patients, the prevalence of β-amyloid deposits was 5.6% (2/36). In the 4 corticobasal syndrome patients, 2 were amyloid-positive. Three of the 5 patients with dementia with Lewy bodies showed amyloid positivity, as did 6 of the 29 vascular dementia (20.7%) patients. The ApoEε4 allele frequency was significantly increased in amyloid-positive CI patients (30.5%) as compared with other amyloid-negative CI patients (14%) or controls (7.3%). Conclusion: Amyloid imaging may potentially be the most helpful parameter for differential diagnosis in dementia, particularly to distinguish between AD and FTD. Amyloid PET can be used in conjunction with the ApoEε4 allele genetic risk test for amyloid deposits.
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Affiliation(s)
- Zhihong Shi
- Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Department of Neurology, Tianjin Dementia Institute, Tianjin Huanhu Hospital, Tianjin, China
| | - Li-Ping Fu
- Department of Nuclear Medicine, 1st Medical Center, Chinese PLA (People's Liberation Army) General Hospital, Beijing, China.,Department of Nuclear Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Nan Zhang
- Department of Neurology, General Hospital of Tianjin Medical University, Tianjin, China
| | - Xiaobin Zhao
- Department of Nuclear Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shuai Liu
- Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Department of Neurology, Tianjin Dementia Institute, Tianjin Huanhu Hospital, Tianjin, China
| | - Chuantao Zuo
- PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Li Cai
- Department of PET-CT Diagnostics, Tianjin Medical University General Hospital, Tianjin, China
| | - Ying Wang
- Department of PET-CT Diagnostics, Tianjin Medical University General Hospital, Tianjin, China
| | - Shuo Gao
- Department of PET-CT Diagnostics, Tianjin Medical University General Hospital, Tianjin, China
| | - Lin Ai
- Department of Nuclear Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi-Hui Guan
- PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Baixuan Xu
- Department of Nuclear Medicine, 1st Medical Center, Chinese PLA (People's Liberation Army) General Hospital, Beijing, China
| | - Yong Ji
- Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Department of Neurology, Tianjin Dementia Institute, Tianjin Huanhu Hospital, Tianjin, China .,China National Clinical Research Center for Neurological Diseases, Beijing, China; and.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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The Brain Metabolic Correlates of the Main Indices of Neuropsychological Assessment in Alzheimer's Disease. J Pers Med 2020; 10:jpm10020025. [PMID: 32325686 PMCID: PMC7354489 DOI: 10.3390/jpm10020025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 11/24/2022] Open
Abstract
Background: The study aimed to investigate the relationships between F-18 fluorodeoxyglucose (18F)FDG uptake and neuropsychological assessment in Alzheimer’s disease (AD). Methods: We evaluated 116 subjects with AD according to the NINCDS-ADRDA criteria. All the subjects underwent a brain PET/CT with (18F)FDG, cerebrospinal fluid (CSF) assay, mini-mental state examination (MMSE) and further neuropsychological tests: Rey auditory verbal learning test, immediate recall (RAVLT immediate); Rey auditory verbal learning test, delayed recall (RAVLT, delayed); Rey complex figure test, copy (RCFT, copy); Rey complex figure test, delayed recall (RCFT, delayed); Raven’s colored progressive matrices (RCPM); phonological word fluency test (PWF) and Stroop test. We performed the statistical analysis by using statistical parametric mapping (SPM12; Wellcome Department of Cognitive Neurology, London, UK). Results: A significant relationship has been reported between (18F)FDG uptake and RAVLT immediate test in Brodmann area (BA)37 and BA22 and with RCFT, copy in BA40, and BA7. We did not find any significant relationships with other tests. Conclusion: In the AD population, brain (18F)FDG uptake is moderately related to the neuropsychological assessment, suggesting a limited impact on statistical data analysis of glucose brain metabolism.
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12
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The Effect of Clinical Characteristics and Subtypes on Amyloid Positivity in Patients with Amnestic Mild Cognitive Impairment. Dement Neurocogn Disord 2020; 18:130-137. [PMID: 31942172 PMCID: PMC6946617 DOI: 10.12779/dnd.2019.18.4.130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/07/2019] [Accepted: 10/31/2019] [Indexed: 11/27/2022] Open
Abstract
Background and Purpose Mild cognitive impairment (MCI) is a prodromal stage of dementia. Amyloid deposits in positron-emission tomography (PET) imaging of MCI patients imply a higher risk for advancing to dementia, with rates of 10%–15% yearly. The purpose of this study was to investigate the clinical characteristics of subgroups of amnestic MCI (aMCI) that may have a higher impact on amyloid positivity. Methods We recruited 136 aMCI patients. All patients underwent a 20-minute F-18 florbetaben or flutemetamol PET scan. We classified amyloid PET images as positive or negative according to a semi-quantitative method. We evaluated the amyloid positivity of subgroups of aMCI (early vs. late type, single vs. multiple amnestic type, verbal vs. verbal, and visual amnestic type), and compared baseline clinical characteristics including key risk factors, apolipoprotein E4 (apoE4) genotype, and neuropsychological assessments with amyloid positivity in aMCI. Results The amyloid positivity in total aMCI was 41%. The positivity rate according to subgroup of aMCI were as follow: Late aMCI (49%) vs. early aMCI (33%) (p=0.13), multiple aMCI (40%) vs. single aMCI (38%) (p=0.51), and verbal and visual aMCI (59%) vs. verbal aMCI (35%) (p=0.01), respectively. The mean age and the frequency of apoE4 allele of the amyloid-positive group was higher than that of the amyloid-negative group in aMCI (p<0.01). Conclusions We found that the amyloid positivity was related to patterns of clinical subtypes, characteristics, and risk factors in patients with aMCI.
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André C, Tomadesso C, de Flores R, Branger P, Rehel S, Mézenge F, Landeau B, Sayette VDL, Eustache F, Chételat G, Rauchs G. Brain and cognitive correlates of sleep fragmentation in elderly subjects with and without cognitive deficits. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2019; 11:142-150. [PMID: 30788411 PMCID: PMC6369144 DOI: 10.1016/j.dadm.2018.12.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction Sleep disturbances are increasingly recognized as a risk factor for Alzheimer's disease. However, no study has assessed the relationships between objective sleep fragmentation (SF) and brain and cognitive integrity across different cognitive stages, from cognitively unimpaired elderly subjects to patients with subjective cognitive decline and/or mild cognitive impairment. Methods 30 cognitively unimpaired elderly participants and 36 patients with subjective cognitive decline and/or mild cognitive impairment underwent a neuropsychological evaluation, structural MRI, 18F-fluorodeoxyglucose, and 18F-florbetapir-PET scans, and an actigraphy recording over a minimum of six consecutive nights. Multiple regression and mediation analyses were performed between SF parameters, neuroimaging data, and cognitive scores. Results In cognitively unimpaired elderly participants, SF intensity mediated the association between frontohippocampal hypometabolism and lower executive functioning. Moreover, to a lower extent, increased SF variability was related to thalamic atrophy and ventromedial prefrontal amyloid burden. However, in patients with subjective cognitive decline and/or mild cognitive impairment, SF no longer contributed to the expression of cognitive deficits. Discussion These findings suggest that SF may directly contribute to lower cognitive performance in cognitively unimpaired elderly subjects. Therefore, treating sleep disturbances before the onset of cognitive deficits may help to cope with brain alterations and maintain cognitive functioning.
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Affiliation(s)
- Claire André
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH, Caen, France
| | - Clémence Tomadesso
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH, Caen, France
- Université Normandie, Inserm, UNICAEN, Inserm UMR-S 1237, GIP Cyceron, Caen, France
| | - Robin de Flores
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH, Caen, France
- Université Normandie, Inserm, UNICAEN, Inserm UMR-S 1237, GIP Cyceron, Caen, France
| | - Pierre Branger
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH, Caen, France
| | - Stéphane Rehel
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH, Caen, France
| | - Florence Mézenge
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH, Caen, France
- Université Normandie, Inserm, UNICAEN, Inserm UMR-S 1237, GIP Cyceron, Caen, France
| | - Brigitte Landeau
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH, Caen, France
- Université Normandie, Inserm, UNICAEN, Inserm UMR-S 1237, GIP Cyceron, Caen, France
| | - Vincent de la Sayette
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH, Caen, France
| | - Francis Eustache
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH, Caen, France
| | - Gaël Chételat
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH, Caen, France
- Université Normandie, Inserm, UNICAEN, Inserm UMR-S 1237, GIP Cyceron, Caen, France
| | - Géraldine Rauchs
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH, Caen, France
- Corresponding author. Tel.: +33(0)231470134; Fax: +33(0)231470275.
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Is there a specific memory signature associated with Aβ-PET positivity in patients with amnestic mild cognitive impairment? Neurobiol Aging 2019; 77:94-103. [PMID: 30784816 DOI: 10.1016/j.neurobiolaging.2019.01.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/17/2019] [Accepted: 01/21/2019] [Indexed: 01/28/2023]
Abstract
Amnestic mild cognitive impairment (aMCI) is a clinical entity with various potential etiologies including but not limited to Alzheimer's disease. We examined whether a positive ([18F]Florbetapir) beta amyloid positron emission tomography scan, supporting underlying Alzheimer's disease pathophysiology, was associated with specific memory deficits in 48 patients with aMCI (33 beta amyloid positive, 15 beta amyloid negative). Memory was evaluated using an autobiographical fluency task and a word-list learning task with 2 different encoding types (shallow/incidental versus deep/intentional). Compared with 40 beta amyloid-negative controls, both aMCI subgroups demonstrated severe deficits in the global memory score and in most subscores of both tasks. Finer-grained analyses of memory tests showed subtle association with beta amyloid status, revealing a stronger impairment of the primacy effect in beta amyloid-positive patients. Structural magnetic resonance imaging showed that both aMCI subgroups exhibited comparable atrophy patterns, with similar degrees of medial temporal volume loss compared with controls. Specifically assessing the primacy effect might complement global memory scores in identifying beta amyloid-positive patients with aMCI.
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