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Chen K, Wang M, Wu J, Zuo C, Huang Y, Wang W, Zhao M, Zhang Y, Zhang X, Chen S, Liu W, Li M, Ge J, Ma X, Wang J, Zheng L, Guan Y, Dong Q, Cui M, Xie F, Zhao Q, Yu J. Incremental value of amyloid PET in a tertiary memory clinic setting in China. Alzheimers Dement 2024; 20:2516-2525. [PMID: 38329281 PMCID: PMC11032579 DOI: 10.1002/alz.13728] [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: 12/08/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 02/09/2024]
Abstract
INTRODUCTION The objective of this study is to investigate the incremental value of amyloid positron emission tomography (Aβ-PET) in a tertiary memory clinic setting in China. METHODS A total of 1073 patients were offered Aβ-PET using 18F-florbetapir. The neurologists determined a suspected etiology (Alzheimer's disease [AD] or non-AD) with a percentage estimate of their confidence and medication prescription both before and after receiving the Aβ-PET results. RESULTS After disclosure of the Aβ-PET results, etiological diagnoses changed in 19.3% of patients, and diagnostic confidence increased from 69.3% to 85.6%. Amyloid PET results led to a change of treatment plan in 36.5% of patients. Compared to the late-onset group, the early-onset group had a more frequent change in diagnoses and a higher increase in diagnostic confidence. DISCUSSION Aβ-PET has significant impacts on the changes of diagnoses and management in Chinese population. Early-onset cases are more likely to benefit from Aβ-PET than late-onset cases. HIGHLIGHTS Amyloid PET contributes to diagnostic changes and its confidence in Chinese patients. Amyloid PET leads to a change of treatment plans in Chinese patients. Early-onset cases are more likely to benefit from amyloid PET than late-onset cases.
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Affiliation(s)
- Ke‐Liang Chen
- Department of Neurology and National Center for Neurological DiseasesHuashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Ming‐Yu Wang
- School of MedicineQingdao UniversityQingdaoShandongChina
- Departments of NeurologyWeifang People's HospitalWeifangShandongChina
| | - Jie Wu
- Department of Neurology and National Center for Neurological DiseasesHuashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Chuan‐Tao Zuo
- Department of Nuclear Medicine & PET CenterHuashan HospitalFudan UniversityShanghaiChina
| | - Yu‐Yuan Huang
- Department of Neurology and National Center for Neurological DiseasesHuashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Wei‐Yi Wang
- Department of Nuclear Medicine & PET CenterHuashan HospitalFudan UniversityShanghaiChina
| | - Meng Zhao
- Department of Neurologythe First Hospital of Jilin UniversityChangchunJilinChina
| | - Ya‐Ru Zhang
- Department of Neurology and National Center for Neurological DiseasesHuashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Xue Zhang
- Department of NeurologyQingdao shi zhongxin yiyuanQingdaoShandongChina
| | - Shu‐Fen Chen
- Department of Neurology and National Center for Neurological DiseasesHuashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Wei‐Shi Liu
- Department of Neurology and National Center for Neurological DiseasesHuashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Meng‐Meng Li
- Department of Neurology and National Center for Neurological DiseasesHuashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Jing‐Jie Ge
- Department of Nuclear Medicine & PET CenterHuashan HospitalFudan UniversityShanghaiChina
| | - Xiao‐Xi Ma
- Department of Neurology and National Center for Neurological DiseasesHuashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Jie Wang
- Department of Neurology and National Center for Neurological DiseasesHuashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Li Zheng
- Department of Neurology and National Center for Neurological DiseasesHuashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Yi‐Hui Guan
- Department of Nuclear Medicine & PET CenterHuashan HospitalFudan UniversityShanghaiChina
| | - Qiang Dong
- Department of Neurology and National Center for Neurological DiseasesHuashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Mei Cui
- Department of Neurology and National Center for Neurological DiseasesHuashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Fang Xie
- Department of Nuclear Medicine & PET CenterHuashan HospitalFudan UniversityShanghaiChina
| | - Qian‐Hua Zhao
- Department of Neurology and National Center for Neurological DiseasesHuashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Jin‐Tai Yu
- Department of Neurology and National Center for Neurological DiseasesHuashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan UniversityShanghaiChina
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Teipel SJ, Spottke A, Boecker H, Daamen M, Graf E, Sahlmann J, Buchert R, Mohnike W, Mohnike K, Kurth J, Jessen F, Krause BJ. Patient-related benefits of amyloid PET imaging in dementia: Rationale and design of the German randomized coverage with evidence development study ENABLE. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2023; 9:e12383. [PMID: 37560401 PMCID: PMC10407881 DOI: 10.1002/trc2.12383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/17/2023] [Accepted: 03/24/2023] [Indexed: 08/11/2023]
Abstract
UNLABELLED The utility of amyloid positron emission tomography (PET) for the etiological diagnosis of dementia and its impact on functional status of patients in routine care are currently unclear. Here, we describe the design of ENABLE, a randomized controlled two-armed coverage with evidence development (CED) study in Germany. Approximately 1126 patients with mild to moderate dementia of unclear etiology will be randomly assigned to either an amyloid PET or a no amyloid PET group. Patients will be followed-up for 24 months. The study has been registered at the German Clinical Trials Register (https://drks.de/search/de/trial/DRKS00030839) with the registration code DRKS00030839. The primary endpoint of ENABLE is the ability to perform functional activities of daily living at 18 months. Secondary endpoints include change in diagnosis, diagnostic confidence, and cognitive and clinical outcomes of patients. We expect that the CED study ENABLE will inform about patient relevant effects of amyloid PET in routine care. Furthermore, we anticipate that ENABLE will support physicians' and payers' decisions on provision of health care for patients with dementia. HIGHLIGHTS Study design focuses on the usefulness of amyloid positron emission tomography (PET) in routine care.Study design addresses the patient-relevant effect of amyloid PET.Patient representatives were involved in the creation of the study design.The study will help improve routine care for people with dementia.
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Affiliation(s)
- Stefan J. Teipel
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Rostock/GreifswaldRostockGermany
- Department of Psychosomatic MedicineRostock University Medical CenterRostockGermany
| | - Annika Spottke
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) BonnBonnGermany
| | - Henning Boecker
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) BonnBonnGermany
| | - Marcel Daamen
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) BonnBonnGermany
| | - Erika Graf
- Institute of Medical Biometry and Statistics (IMBI)Faculty of Medicine − University Medical Center FreiburgFreiburgGermany
| | - Jörg Sahlmann
- Institute of Medical Biometry and Statistics (IMBI)Faculty of Medicine − University Medical Center FreiburgFreiburgGermany
| | - Ralph Buchert
- Department of Diagnostic and Interventional Radiology and Nuclear MedicineUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Wolfgang Mohnike
- PET e.V.BerlinGermany
- Diagnostic Therapeutic Center Berlin‐Frankfurter TorBerlinGermany
| | - Konrad Mohnike
- PET e.V.BerlinGermany
- Diagnostic Therapeutic Center Berlin‐Frankfurter TorBerlinGermany
| | - Jens Kurth
- Department of Nuclear MedicineRostock University Medical CenterRostockGermany
| | - Frank Jessen
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) BonnBonnGermany
- Department of PsychiatryUniversity Hospital of Cologne, Medical Faculty, University of CologneCologneGermany
| | - Bernd J. Krause
- Department of Nuclear MedicineRostock University Medical CenterRostockGermany
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FDA approval of lecanemab: the real start of widespread amyloid PET use? - the EANM Neuroimaging Committee perspective. Eur J Nucl Med Mol Imaging 2023; 50:1553-1555. [PMID: 36869178 PMCID: PMC10119064 DOI: 10.1007/s00259-023-06177-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
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Clinical impact of amyloid PET using 18F-florbetapir in patients with cognitive impairment and suspected Alzheimer's disease: a multicenter study. Ann Nucl Med 2022; 36:1039-1049. [PMID: 36194355 DOI: 10.1007/s12149-022-01792-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/27/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Amyloid positron emission tomography (PET) can reliably detect senile plaques and fluorinated ligands are approved for clinical use. However, the clinical impact of amyloid PET imaging is still under investigation. The aim of this study was to evaluate the diagnostic impact and clinical utility in patient management of amyloid PET using 18F-florbetapir in patients with cognitive impairment and suspected Alzheimer's disease (AD). We also aimed to determine the cutoffs for amyloid positivity for quantitative measures by investigating the agreement between quantitative and visual assessments. METHODS Ninety-nine patients suspected of having AD underwent 18F-florbetapir PET at five institutions. Site-specialized physicians provided a diagnosis of AD or non-AD with a percentage estimate of their confidence and their plan for patient management in terms of medication, prescription dosage, additional diagnostic tests, and care planning both before and after receiving the amyloid imaging results. A PET image for each patient was visually assessed and dichotomously rated as either amyloid-positive or amyloid-negative by four board-certified nuclear medicine physicians. The PET images were also quantitatively analyzed using the standardized uptake value ratio (SUVR) and Centiloid (CL) scale. RESULTS Visual interpretation obtained 48 positive and 51 negative PET scans. The amyloid PET results changed the AD and non-AD diagnosis in 39 of 99 patients (39.3%). The change rates of 26 of the 54 patients (48.1%) with a pre-scan AD diagnosis were significantly higher than those of 13 of the 45 patients with a pre-scan non-AD diagnosis (χ2 = 5.334, p = 0.0209). Amyloid PET results also resulted in at least one change to the patient management plan in 42 patients (42%), mainly medication (20 patients, 20%) and care planning (25 patients, 25%). Receiver-operating characteristic analysis determined the best agreement of the quantitative assessments and visual interpretation of PET scans to have an area under the curve of 0.993 at an SUVR of 1.19 and CL of 25.9. CONCLUSION Amyloid PET using 18F-florbetapir PET had a substantial clinical impact on AD and non-AD diagnosis and on patient management by enhancing diagnostic confidence. In addition, the quantitative measures may improve the visual interpretation of amyloid positivity.
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Turk KW, Vives‐Rodriguez A, Schiloski KA, Marin A, Wang R, Singh P, Hajos GP, Powsner R, DeCaro R, Budson AE. Amyloid PET ordering practices in a memory disorders clinic. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2022; 8:e12333. [PMID: 35992217 PMCID: PMC9382692 DOI: 10.1002/trc2.12333] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/14/2022] [Accepted: 06/01/2022] [Indexed: 11/29/2022]
Abstract
Introduction This study assessed the ordering of amyloid positron emission tomography (PET) scans in a Veterans Affairs (VA) memory disorders clinic as part of routine clinical care, with possible implications for the extent to which ordering may occur outside of the VA in the future if covered by insurance. Methods Clinical features predictive of ordering amyloid PET scans were retrospectively assessed; the percentage of patients who met appropriate use criteria were evaluated. Results Among 565 veterans, 34.9% of received an amyloid PET scan and 98.0% of these were consistent with appropriate use criteria. Patients with a PET were younger and more likely to have an initial diagnosis of Alzheimer's disease (AD). Of patients without an amyloid PET scan ordered, 64.4% would have met appropriate use criteria for amyloid PET. Discussion The majority of scans ordered were consistent with appropriate use criteria and more patients were eligible than received a scan. The current study's findings that approximately one-third of patients in a memory disorders clinic received an amyloid PET scan has implications for memory disorders clinics inside and outside of the US Veterans Health Administration.
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Affiliation(s)
- Katherine W. Turk
- Center for Translational Cognitive NeuroscienceVA Boston Healthcare SystemBostonMassachusettsUSA
- Department of NeurologyBoston University School of MedicineBostonMassachusettsUSA
- Alzheimer's Disease Research CenterDepartment of NeurologyBoston University School of MedicineBostonMassachusettsUSA
| | - Ana Vives‐Rodriguez
- Center for Translational Cognitive NeuroscienceVA Boston Healthcare SystemBostonMassachusettsUSA
- Department of NeurologyBoston University School of MedicineBostonMassachusettsUSA
| | - Kylie A. Schiloski
- Center for Translational Cognitive NeuroscienceVA Boston Healthcare SystemBostonMassachusettsUSA
| | - Anna Marin
- Center for Translational Cognitive NeuroscienceVA Boston Healthcare SystemBostonMassachusettsUSA
- Neuroscience DepartmentBoston University School of Medicine BostonBostonMassachusettsUSA
| | - Ryan Wang
- Department of NeurologyBoston University School of MedicineBostonMassachusettsUSA
| | - Prabhjyot Singh
- Center for Translational Cognitive NeuroscienceVA Boston Healthcare SystemBostonMassachusettsUSA
| | - Gabor P. Hajos
- Center for Translational Cognitive NeuroscienceVA Boston Healthcare SystemBostonMassachusettsUSA
| | - Rachel Powsner
- Department of RadiologyVA Boston Healthcare SystemBostonMassachusettsUSA
| | - Renée DeCaro
- Center for Translational Cognitive NeuroscienceVA Boston Healthcare SystemBostonMassachusettsUSA
- Department of NeurologyBoston University School of MedicineBostonMassachusettsUSA
| | - Andrew E. Budson
- Center for Translational Cognitive NeuroscienceVA Boston Healthcare SystemBostonMassachusettsUSA
- Department of NeurologyBoston University School of MedicineBostonMassachusettsUSA
- Alzheimer's Disease Research CenterDepartment of NeurologyBoston University School of MedicineBostonMassachusettsUSA
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Vives‐Rodriguez AL, Schiloski KA, Marin A, Wang R, Hajos GP, Powsner R, DeCaro R, Budson AE, Turk KW. Impact of amyloid PET in the clinical care of veterans in a tertiary memory disorders clinic. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2022; 8:e12320. [PMID: 35992216 PMCID: PMC9382691 DOI: 10.1002/trc2.12320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/31/2022] [Accepted: 06/01/2022] [Indexed: 11/16/2022]
Abstract
Introduction We aimed to characterize the clinical impact of amyloid PET (APET) in a veteran population with cognitive decline by comparing differences in management between those who did and did not have an APET. Methods This was a retrospective observational study. Poisson regressions and logistic regression were used for comparisons. Results Out of 565 veterans, 197 underwent APET; positivity rate was 36.55%. Having an APET was associated with longer follow-up, and increased diagnostic variability; it was not associated with number of additional studies, cholinesterase inhibitors prescription, or referrals to research. A positive APET was associated with less diagnostic variability, fewer additional tests, greater cholinesterase inhibitor prescriptions, and more research referrals. Discussion In a medically complex, real-world population, APET yielded lower positivity rates and was not associated with classical clinical utility variables when comparing patients with and without an APET. APET may be used more to "rule out" rather than to confirm Alzheimer's disease. Highlights Amyloid PET was associated with longer follow-up, and higher diagnostic variability.No association was seen with cholinesterase inhibitors prescription, or referrals to research.In complex patients, expected amyloid PET positivity rates are lower than previously described.Amyloid PETs were used to "rule out" AD than to confirm the diagnosis of AD.
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Affiliation(s)
- Ana Laura Vives‐Rodriguez
- Center for Translational Cognitive NeuroscienceVA Boston Healthcare SystemBostonMassachusettsUSA
- Department of NeurologyBoston University School of MedicineBostonMassachusettsUSA
| | - Kylie A. Schiloski
- Center for Translational Cognitive NeuroscienceVA Boston Healthcare SystemBostonMassachusettsUSA
| | - Anna Marin
- Center for Translational Cognitive NeuroscienceVA Boston Healthcare SystemBostonMassachusettsUSA
- Neuroscience DepartmentBoston University School of Medicine BostonMassachusettsUSA
| | - Ryan Wang
- Department of NeurologyBoston University School of MedicineBostonMassachusettsUSA
| | - Gabor P. Hajos
- Center for Translational Cognitive NeuroscienceVA Boston Healthcare SystemBostonMassachusettsUSA
| | - Rachel Powsner
- Department of RadiologyVA Boston Healthcare SystemBostonMassachusettsUSA
| | - Renée DeCaro
- Center for Translational Cognitive NeuroscienceVA Boston Healthcare SystemBostonMassachusettsUSA
- Department of NeurologyBoston University School of MedicineBostonMassachusettsUSA
| | - Andrew E. Budson
- Center for Translational Cognitive NeuroscienceVA Boston Healthcare SystemBostonMassachusettsUSA
- Department of NeurologyBoston University School of MedicineBostonMassachusettsUSA
- Alzheimer's Disease Research CenterDepartment of NeurologyBoston University School of MedicineBostonMassachusettsUSA
| | - Katherine W. Turk
- Center for Translational Cognitive NeuroscienceVA Boston Healthcare SystemBostonMassachusettsUSA
- Department of NeurologyBoston University School of MedicineBostonMassachusettsUSA
- Alzheimer's Disease Research CenterDepartment of NeurologyBoston University School of MedicineBostonMassachusettsUSA
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Pemberton HG, Collij LE, Heeman F, Bollack A, Shekari M, Salvadó G, Alves IL, Garcia DV, Battle M, Buckley C, Stephens AW, Bullich S, Garibotto V, Barkhof F, Gispert JD, Farrar G. Quantification of amyloid PET for future clinical use: a state-of-the-art review. Eur J Nucl Med Mol Imaging 2022; 49:3508-3528. [PMID: 35389071 PMCID: PMC9308604 DOI: 10.1007/s00259-022-05784-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/25/2022] [Indexed: 12/15/2022]
Abstract
Amyloid-β (Aβ) pathology is one of the earliest detectable brain changes in Alzheimer's disease (AD) pathogenesis. The overall load and spatial distribution of brain Aβ can be determined in vivo using positron emission tomography (PET), for which three fluorine-18 labelled radiotracers have been approved for clinical use. In clinical practice, trained readers will categorise scans as either Aβ positive or negative, based on visual inspection. Diagnostic decisions are often based on these reads and patient selection for clinical trials is increasingly guided by amyloid status. However, tracer deposition in the grey matter as a function of amyloid load is an inherently continuous process, which is not sufficiently appreciated through binary cut-offs alone. State-of-the-art methods for amyloid PET quantification can generate tracer-independent measures of Aβ burden. Recent research has shown the ability of these quantitative measures to highlight pathological changes at the earliest stages of the AD continuum and generate more sensitive thresholds, as well as improving diagnostic confidence around established binary cut-offs. With the recent FDA approval of aducanumab and more candidate drugs on the horizon, early identification of amyloid burden using quantitative measures is critical for enrolling appropriate subjects to help establish the optimal window for therapeutic intervention and secondary prevention. In addition, quantitative amyloid measurements are used for treatment response monitoring in clinical trials. In clinical settings, large multi-centre studies have shown that amyloid PET results change both diagnosis and patient management and that quantification can accurately predict rates of cognitive decline. Whether these changes in management reflect an improvement in clinical outcomes is yet to be determined and further validation work is required to establish the utility of quantification for supporting treatment endpoint decisions. In this state-of-the-art review, several tools and measures available for amyloid PET quantification are summarised and discussed. Use of these methods is growing both clinically and in the research domain. Concurrently, there is a duty of care to the wider dementia community to increase visibility and understanding of these methods.
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Affiliation(s)
- Hugh G Pemberton
- GE Healthcare, Amersham, UK.
- Centre for Medical Image Computing (CMIC), Department of Medical Physics and Bioengineering, University College London, London, UK.
- UCL Queen Square Institute of Neurology, University College London, London, UK.
| | - Lyduine E Collij
- Department of Radiology and Nuclear Medicine, Amsterdam Neurocience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Fiona Heeman
- Department of Radiology and Nuclear Medicine, Amsterdam Neurocience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ariane Bollack
- Centre for Medical Image Computing (CMIC), Department of Medical Physics and Bioengineering, University College London, London, UK
| | - Mahnaz Shekari
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Gemma Salvadó
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Isadora Lopes Alves
- Department of Radiology and Nuclear Medicine, Amsterdam Neurocience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Brain Research Center, Amsterdam, The Netherlands
| | - David Vallez Garcia
- Department of Radiology and Nuclear Medicine, Amsterdam Neurocience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mark Battle
- GE Healthcare, Amersham, UK
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | | | | | | | - Valentina Garibotto
- Division of Nuclear Medicine and Molecular Imaging, University Hospitals of Geneva, Geneva, Switzerland
- NIMTLab, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Frederik Barkhof
- Centre for Medical Image Computing (CMIC), Department of Medical Physics and Bioengineering, University College London, London, UK
- UCL Queen Square Institute of Neurology, University College London, London, UK
- Department of Radiology and Nuclear Medicine, Amsterdam Neurocience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Juan Domingo Gispert
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Centro de Investigación Biomédica en Red Bioingeniería, Biomateriales y Nanomedicina, Madrid, Spain
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Altomare D, Collij L, Caprioglio C, Scheltens P, van Berckel BNM, Alves IL, Berkhof J, de Gier Y, Garibotto V, Moro C, Poitrine L, Delrieu J, Payoux P, Saint-Aubert L, Molinuevo JL, Grau-Rivera O, Gispert JD, Minguillón C, Fauria K, Sanchez MF, Rădoi A, Drzezga A, Jessen F, Escher C, Zeyen P, Nordberg A, Savitcheva I, Jelic V, Walker Z, Lee HY, Lee L, Demonet JF, Plaza Wuthrich S, Gismondi R, Farrar G, Barkhof F, Stephens AW, Frisoni GB. Description of a European memory clinic cohort undergoing amyloid-PET: The AMYPAD Diagnostic and Patient Management Study. Alzheimers Dement 2022; 19:844-856. [PMID: 35715930 DOI: 10.1002/alz.12696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 03/11/2022] [Accepted: 04/29/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION AMYPAD Diagnostic and Patient Management Study (DPMS) aims to investigate the clinical utility and cost-effectiveness of amyloid-PET in Europe. Here we present participants' baseline features and discuss the representativeness of the cohort. METHODS Participants with subjective cognitive decline plus (SCD+), mild cognitive impairment (MCI), or dementia were recruited in eight European memory clinics from April 16, 2018, to October 30, 2020, and randomized into three arms: ARM1, early amyloid-PET; ARM2, late amyloid-PET; and ARM3, free-choice. RESULTS A total of 840 participants (244 SCD+, 341 MCI, and 255 dementia) were enrolled. Sociodemographic/clinical features did not differ significantly among recruiting memory clinics or with previously reported cohorts. The randomization assigned 35% of participants to ARM1, 32% to ARM2, and 33% to ARM3; cognitive stages were distributed equally across the arms. DISCUSSION The features of AMYPAD-DPMS participants are as expected for a memory clinic population. This ensures the generalizability of future study results.
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Affiliation(s)
- Daniele Altomare
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
- Geneva Memory Center, Geneva University Hospitals, Geneva, Switzerland
| | - Lyduine Collij
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (UMC) - Location VUmc, Amsterdam, The Netherlands
| | - Camilla Caprioglio
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
- Geneva Memory Center, Geneva University Hospitals, Geneva, Switzerland
| | - Philip Scheltens
- Alzheimer Center, Department of Neurology, Amsterdam University Medical Centers (UMC) - Location VUmc, Amsterdam, The Netherlands
| | - Bart N M van Berckel
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (UMC) - Location VUmc, Amsterdam, The Netherlands
| | - Isadora Lopes Alves
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (UMC) - Location VUmc, Amsterdam, The Netherlands
| | - Johannes Berkhof
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers (UMC) - Location VUmc, Amsterdam, The Netherlands
| | - Yvonne de Gier
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (UMC) - Location VUmc, Amsterdam, The Netherlands
| | - Valentina Garibotto
- Laboratory of Neuroimaging and Innovative Molecular Tracers (NIMTlab), Geneva University Neurocenter and Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals, Geneva, Switzerland
| | - Christian Moro
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
- Geneva Memory Center, Geneva University Hospitals, Geneva, Switzerland
| | - Léa Poitrine
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
- Geneva Memory Center, Geneva University Hospitals, Geneva, Switzerland
| | - Julien Delrieu
- Gérontopôle, Department of Geriatrics, Toulouse University Hospital, Toulouse, France
- Maintain Aging Research team, CERPOP, Inserm, Université Paul Sabatier, Toulouse, France
| | - Pierre Payoux
- Department of Nuclear Medicine, Toulouse University Hospital, Toulouse, France
- Toulouse NeuroImaging Center (ToNIC), Inserm, Université Paul Sabatier, Toulouse, France
| | - Laure Saint-Aubert
- Department of Nuclear Medicine, Toulouse University Hospital, Toulouse, France
- Toulouse NeuroImaging Center (ToNIC), Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - José Luis Molinuevo
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- H. Lundbeck A/S, Copenhagen, Denmark
| | - Oriol Grau-Rivera
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - Juan-Domingo Gispert
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red Bioingeniería, Biomateriales y Nanomedicina, (CIBER-BBN), Barcelona, Spain
| | - Carolina Minguillón
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - Karine Fauria
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - Marta Felez Sanchez
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
| | - Andreea Rădoi
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
| | - Alexander Drzezga
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn-Cologne, Germany
- Institute of Neuroscience and Medicine (INM-2), Molecular Organization of the Brain, Forschungszentrum Jülich, Germany
| | - Frank Jessen
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Claus Escher
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Philip Zeyen
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Agneta Nordberg
- Department of Neurobiology, Care Sciences and Society, Center of Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
- Theme Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Irina Savitcheva
- Medical Radiation Physics and Nuclear Medicine, Section for Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Vesna Jelic
- Cognitive Disorders Clinic, Theme Inflammation and Aging, Karolinska University Hospital-Huddinge, Stockholm, Sweden
| | - Zuzana Walker
- Division of Psychiatry, University College London, London, UK
- St. Margaret's Hospital, Essex Partnership University NHS Foundation Trust, Essex, UK
| | - Ho-Yun Lee
- St. Margaret's Hospital, Essex Partnership University NHS Foundation Trust, Essex, UK
| | - Lean Lee
- Division of Psychiatry, University College London, London, UK
| | | | - Sonia Plaza Wuthrich
- Leenaards Memory Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | | | | | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (UMC) - Location VUmc, Amsterdam, The Netherlands
- Institutes of Neurology and Healthcare Engineering, UCL, London, UK
| | | | - Giovanni B Frisoni
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
- Geneva Memory Center, Geneva University Hospitals, Geneva, Switzerland
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9
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Functional Imaging for Neurodegenerative Diseases. Presse Med 2022; 51:104121. [PMID: 35490910 DOI: 10.1016/j.lpm.2022.104121] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 03/13/2022] [Accepted: 04/11/2022] [Indexed: 12/16/2022] Open
Abstract
Diagnosis and monitoring of neurodegenerative diseases has changed profoundly over the past twenty years. Biomarkers are now included in most diagnostic procedures as well as in clinical trials. Neuroimaging biomarkers provide access to brain structure and function over the course of neurodegenerative diseases. They have brought new insights into a wide range of neurodegenerative diseases and have made it possible to describe some of the imaging challenges in clinical populations. MRI mainly explores brain structure while molecular imaging, functional MRI and electro- and magnetoencephalography examine brain function. In this paper, we describe and analyse the current and potential contribution of MRI and molecular imaging in the field of neurodegenerative diseases.
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10
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Soo SA, Zailan FZ, Tan JY, Sandhu GK, Wong BYX, Wang BZ, Ng ASL, Chiew HJ, Ng KP, Kandiah N. Safety and Usefulness of Lumbar Puncture for the Diagnosis and Management of Young-Onset Cognitive Disorders. J Alzheimers Dis 2022; 87:479-488. [PMID: 35275537 DOI: 10.3233/jad-215453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Young-onset cognitive disorders (YOCD) often manifests with complex and atypical presentations due to underlying heterogenous pathologies. Therefore, a biomarker-based evaluation will allow for timely diagnosis and definitive management. OBJECTIVE Here, we evaluated the safety and usefulness of cerebrospinal fluid (CSF) sampling through lumbar puncture (LP) in YOCD patients in a tertiary clinical setting. METHODS Patients with mild cognitive impairment (MCI) and mild dementia with age of onset between 45-64 years were evaluated. Patients underwent magnetic resonance imaging and their medial temporal lobe atrophy (MTA) was rated. LP side-effects and the impact of the CSF findings on diagnosis and management were analyzed. RESULTS 142 patients (53 (37.32%) MCI, 51 (35.92%) dementia of the Alzheimer's disease [DAT] type, and 38 (26.76%) non-AD type dementia) who underwent LP between 2015 to 2021 were analyzed. Using post-LP results and MTA ratings, 74 (52.11%) patients met the AT(N) criteria for AD. 56 (39.44%) patients (28 out of 53 (50.0%) MCI, 12 out of 51 (21.43%) DAT, and 16 out of 38 (28.57%) non-AD dementia) had a change in diagnosis following LP. 13 (9.15%) patients developed side-effects post-LP (11 (84.62%) patients had headache, 1 (7.69%) patient had backache, and 1 (7.69%) patient had headache and backache). 32 (22.54%) patients had a change in management post-LP, 24 (75.0%) had medication changes, 10 (31.30%) had referrals to other specialists, and 3 (9.40%) was referred for clinical trial with disease modifying interventions. CONCLUSION LP is well-tolerated in YOCD and can bring about relevant clinical decisions with regards to the diagnosis and management of this complex clinical condition.
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Affiliation(s)
- See Ann Soo
- Department of Neurology, National Neuroscience Institute, Singapore
| | | | - Jayne Yi Tan
- Department of Neurology, National Neuroscience Institute, Singapore
| | | | | | | | | | - Hui Jin Chiew
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Kok Pin Ng
- Department of Neurology, National Neuroscience Institute, Singapore.,Duke NUS Medical School, Singapore.,Lee Kong Chian School of Medicine-NTU, Singapore
| | - Nagaendran Kandiah
- Department of Neurology, National Neuroscience Institute, Singapore.,Duke NUS Medical School, Singapore.,Lee Kong Chian School of Medicine-NTU, Singapore
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11
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The approval of a disease-modifying treatment for Alzheimer's disease: impact and consequences for the nuclear medicine community. Eur J Nucl Med Mol Imaging 2021; 48:3033-3036. [PMID: 34272989 DOI: 10.1007/s00259-021-05485-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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12
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Vera JH, Eftychiou N, Schuerer M, Rullmann M, Barthel H, Sabri O, Gisslen M, Zetterberg H, Blennow K, O'Brien C, Banerjee S, Dizdarevic S. Clinical Utility of β-Amyloid PET Imaging in People Living With HIV With Cognitive Symptoms. J Acquir Immune Defic Syndr 2021; 87:826-833. [PMID: 33587503 DOI: 10.1097/qai.0000000000002648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/25/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Imaging with β-amyloid (Aβ) positron emission tomography (PET) has the potential to aid the diagnosis of the cause of cognitive impairment affecting people living with HIV (PLWH) when neurodegenerative disorders are considered. We evaluated the clinical utility of [18F]Florbetaben (FBB) in PLWH with cognitive symptoms. METHODS Imaging with FBB PET was performed in 20 patients with cognitive concerns about dementia. Neuropsychological testing, plasma neurofilament light protein, plasma Aβ40, Aβ42, and cerebrospinal fluid Aβ42, tau, and HIV RNA were obtained. FBB PET images were assessed visually by 3 readers blinded to the clinical diagnosis and quantitatively by obtaining a composite cortical to cerebellar cortex standardized uptake value ratio (SUVR). FBB SUVR from 10 age-matched healthy controls was compared with SUVR of PLWH. RESULTS Most participants were men (90%) of white ethnicity (90%) with a median age (interquartile range) of 59 (43-79) years. Median CD4 count was 682 (74-1056). All patients were on combination antiretroviral therapy with plasma and cerebrospinal fluid HIV RNA <40 copies/mL. Fourteen patients had objective cognitive impairment including 2 who met clinical criteria for a diagnosis of dementia. No significant differences in composite SUVRs between PLWH and controls [mean (SD): 1.18 (0.03) vs. 1.16 (0.09); P = 0.37] were observed. Four patients were FBB+ with the highest SUVR in the posterior cingulate, superior temporal, and frontal superior lobe. Amyloid PET results contributed to a change in diagnosis and treatment for 10 patients. CONCLUSION [18F]Florbetaben PET has potential as an adjunctive tool in the diagnosis of PLWH with cognitive impairment, increasing diagnostic certainty and optimizing management.
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Affiliation(s)
- Jaime H Vera
- Centre for Global Health Research, Brighton and Sussex Med School, United Kingdom
| | - Nicholas Eftychiou
- Department of Nuclear Medicine, Brighton and Sussex University Hospitals, United Kingdom
| | - Matti Schuerer
- Department of Nuclear Medicine, University of Leipzig, Germany
| | | | - Henryk Barthel
- Department of Nuclear Medicine, University of Leipzig, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, University of Leipzig, Germany
| | - Magnus Gisslen
- Department of Infectious Diseases, University of Gothenburg, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, University of Gothenburg, Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, University of Gothenburg, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Sweden
| | - Clara O'Brien
- Department of Neuropsychology, Brighton and Sussex University Hospitals, United Kingdom ; and
| | - Sube Banerjee
- Faculty of Health, University of Plymouth, United Kingdom
| | - Sabina Dizdarevic
- Department of Nuclear Medicine, Brighton and Sussex University Hospitals, United Kingdom
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13
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Benvenutto A, Guedj E, Felician O, Eusebio A, Azulay JP, Ceccaldi M, Koric L. Clinical Phenotypes in Corticobasal Syndrome with or without Amyloidosis Biomarkers. J Alzheimers Dis 2021; 74:331-343. [PMID: 32039846 DOI: 10.3233/jad-190961] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Corticobasal syndrome (CBS) is a neuropathologically heterogeneous entity. The use of cerebrospinal fluid and amyloid biomarkers enables detection of underlying Alzheimer's disease (AD) pathology. We thus compared clinical, eye movement, and 18FDG-PET imaging characteristics in CBS in two groups of patients divided according to their amyloid biomarkers profile. Fourteen patients presenting with CBS and amyloidosis (CBS-A+) were compared with 16 CBS patients without amyloidosis (CBS-A-). The two groups showed similar motor abnormalities (parkinsonism, dystonia) and global cognitive functions. Unlike CBS-A+ patients who displayed more posterior cortical abnormalities, CBS-A- patients demonstrated more anterior cortical and brain stem dysfunctions on the basis of neuropsychological testing, study of saccade velocities and brain hypometabolism areas on 18FDG-PET. Interestingly, Dopamine Transporter SPECT imaging showed similar levels of dopaminergic degeneration in both groups. These findings confirm common and distinct brain abnormalities between the different neurodegenerative diseases that result in CBS. We demonstrate the importance of a multidisciplinary approach to improve diagnosis in vivo in particular on oculomotor examination.
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Affiliation(s)
- Agnès Benvenutto
- Department of Neurology and Neuropsychology, and CMMR PACA Ouest, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Eric Guedj
- Department of Nuclear Medecine, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,CERIMED, Aix-Marseille Univ, Marseille, France.,Aix Marseille Univ, UMR 7249, CNRS, Centrale Marseille, Institut Fresnel, Marseille, France
| | - Olivier Felician
- Department of Neurology and Neuropsychology, and CMMR PACA Ouest, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,Aix-Marseille Univ, INSERM UMR 1106, Institut de Neurosciences des Systèmes, Marseille, France
| | - Alexandre Eusebio
- Department of Neurology and Movement Disorders Department, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,Aix-Marseille Univ, CNRS, INT, Institut Neurosciences Timone, Marseille, France
| | - Jean-Philippe Azulay
- Department of Neurology and Movement Disorders Department, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,Aix-Marseille Univ, CNRS, INT, Institut Neurosciences Timone, Marseille, France
| | - Mathieu Ceccaldi
- Department of Neurology and Neuropsychology, and CMMR PACA Ouest, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,Aix-Marseille Univ, INSERM UMR 1106, Institut de Neurosciences des Systèmes, Marseille, France
| | - Lejla Koric
- Department of Neurology and Neuropsychology, and CMMR PACA Ouest, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,Aix Marseille Univ, UMR 7249, CNRS, Centrale Marseille, Institut Fresnel, Marseille, France
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14
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Ni R, Röjdner J, Voytenko L, Dyrks T, Thiele A, Marutle A, Nordberg A. In vitro Characterization of the Regional Binding Distribution of Amyloid PET Tracer Florbetaben and the Glia Tracers Deprenyl and PK11195 in Autopsy Alzheimer's Brain Tissue. J Alzheimers Dis 2021; 80:1723-1737. [PMID: 33749648 PMCID: PMC8150513 DOI: 10.3233/jad-201344] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Emerging evidence indicates a central role of gliosis in Alzheimer's disease (AD) pathophysiology. However, the regional distribution and interaction of astrogliosis and microgliosis in association with amyloid-β (Aβ) still remain uncertain. OBJECTIVE Here we studied the pathological profiles in autopsy AD brain by using specific imaging tracers. METHODS Autopsy brain tissues of AD (n = 15, age 70.4±8.5 years) and control cases (n = 12, age 76.6±10.9) were examined with homogenate binding assays, autoradiography for Aβ plaques (3H-florbetaben/3H-PIB), astrogliosis (3H-L-deprenyl), and microgliosis (3H-PK11195/3H-FEMPA), as well as immunoassays. RESULTS In vitro saturation analysis revealed high-affinity binding sites of 3H-florbetaben, 3H-L-deprenyl, and 3H-PK11195/3H-FEMPA in the frontal cortex of AD cases. In vitro3H-florbetaben binding increased across cortical and subcortical regions of AD compared to control with the highest binding in the frontal and parietal cortices. The in vitro3H-L-deprenyl binding showed highest binding in the hippocampus (dentate gyrus) followed by cortical and subcortical regions of AD while the GFAP expression was upregulated only in the hippocampus compared to control. The in vitro3H-PK11195 binding was solely increased in the parietal cortex and the hippocampus of AD compared to control. The 3H-florbetaben binding positively correlated with the 3H-L-deprenyl binding in the hippocampus and parietal cortex of AD and controls. Similarly, a positive correlation was observed between 3H-florbetaben binding and GFAP expression in hippocampus of AD and control. CONCLUSION The use of multi-imaging tracers revealed different regional pattern of changes in autopsy AD brain with respect to amyloid plaque pathology versus astrogliosis and microgliosis.
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Affiliation(s)
- Ruiqing Ni
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Jennie Röjdner
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Larysa Voytenko
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Amelia Marutle
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Agneta Nordberg
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Theme Aging, The Aging Brain Unit, Karolinska University Hospital, Stockholm, Sweden
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15
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Moscoso A, Grothe MJ, Ashton NJ, Karikari TK, Lantero Rodríguez J, Snellman A, Suárez-Calvet M, Blennow K, Zetterberg H, Schöll M. Longitudinal Associations of Blood Phosphorylated Tau181 and Neurofilament Light Chain With Neurodegeneration in Alzheimer Disease. JAMA Neurol 2021; 78:396-406. [PMID: 33427873 PMCID: PMC7802009 DOI: 10.1001/jamaneurol.2020.4986] [Citation(s) in RCA: 136] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Question What is the potential of blood-based biomarkers for predicting and monitoring the progression of Alzheimer disease neurodegeneration? Findings In this cohort study that included 1113 participants from the multicentric Alzheimer’s Disease Neuroimaging Initiative study, baseline and longitudinal increases of tau phosphorylated at threonine 181 (p-tau181) in blood plasma were associated with progressive, longitudinal neurodegeneration in brain regions characteristic for Alzheimer disease, as well as with cognitive decline, only among participants with elevated brain amyloid-β. Neurofilament light chain in plasma, however, was associated with disease progression independent of amyloid-β and plasma p-tau181. Meaning These findings suggest that plasma p-tau181, alone or combined with plasma neurofilament light chain, can be used as an accessible, minimally invasive biomarker to track Alzheimer disease progression. Importance Plasma phosphorylated tau at threonine 181 (p-tau181) has been proposed as an easily accessible biomarker for the detection of Alzheimer disease (AD) pathology, but its ability to monitor disease progression in AD remains unclear. Objective To study the potential of longitudinal plasma p-tau181 measures for assessing neurodegeneration progression and cognitive decline in AD in comparison to plasma neurofilament light chain (NfL), a disease-nonspecific marker of neuronal injury. Design, Setting, and Participants This longitudinal cohort study included data from the Alzheimer’s Disease Neuroimaging Initiative from February 1, 2007, to June 6, 2016. Follow-up blood sampling was performed for up to 8 years. Plasma p-tau181 measurements were performed in 2020. This was a multicentric observational study of 1113 participants, including cognitively unimpaired participants as well as patients with cognitive impairment (mild cognitive impairment and AD dementia). Participants were eligible for inclusion if they had available plasma p-tau181 and NfL measurements and at least 1 fluorine-18–labeled fluorodeoxyglucose (FDG) positron emission tomography (PET) or structural magnetic resonance imaging scan performed at the same study visit. Exclusion criteria included any significant neurologic disorder other than suspected AD; presence of infection, infarction, or multiple lacunes as detected by magnetic resonance imaging; and any significant systemic condition that could lead to difficulty complying with the protocol. Exposures Plasma p-tau181 and NfL measured with single-molecule array technology. Main Outcomes and Measures Longitudinal imaging markers of neurodegeneration (FDG PET and structural magnetic resonance imaging) and cognitive test scores (Preclinical Alzheimer Cognitive Composite and Alzheimer Disease Assessment Scale–Cognitive Subscale with 13 tasks). Data were analyzed from June 20 to August 15, 2020. Results Of the 1113 participants (mean [SD] age, 74.0 [7.6] years; 600 men [53.9%]; 992 non-Hispanic White participants [89.1%]), a total of 378 individuals (34.0%) were cognitively unimpaired (CU) and 735 participants (66.0%) were cognitively impaired (CImp). Of the CImp group, 537 (73.1%) had mild cognitive impairment, and 198 (26.9%) had AD dementia. Longitudinal changes of plasma p-tau181 were associated with cognitive decline (CU: r = –0.24, P < .001; CImp: r = 0.34, P < .001) and a prospective decrease in glucose metabolism (CU: r = –0.05, P = .48; CImp: r = –0.27, P < .001) and gray matter volume (CU: r = –0.19, P < .001; CImp: r = –0.31, P < .001) in highly AD-characteristic brain regions. These associations were restricted to amyloid-β–positive individuals. Both plasma p-tau181 and NfL were independently associated with cognition and neurodegeneration in brain regions typically affected in AD. However, NfL was also associated with neurodegeneration in brain regions exceeding this AD-typical spatial pattern in amyloid-β–negative participants. Mediation analyses found that approximately 25% to 45% of plasma p-tau181 outcomes on cognition measures were mediated by the neuroimaging-derived markers of neurodegeneration, suggesting links between plasma p-tau181 and cognition independent of these measures. Conclusions and Relevance Study findings suggest that plasma p-tau181 was an accessible and scalable marker for predicting and monitoring neurodegeneration and cognitive decline and was, unlike plasma NfL, AD specific. The study findings suggest implications for the use of plasma biomarkers as measures to monitor AD progression in clinical practice and treatment trials.
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Affiliation(s)
- Alexis Moscoso
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Michel J Grothe
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden.,Unidad de Trastornos del Movimiento, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Nicholas J Ashton
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden.,King's College London, Institute of Psychiatry, Psychology & Neuroscience, Maurice Wohl Clinical Neuroscience Institute, London, United Kingdom.,NIHR Biomedical Research Centre for Mental Health & Biomedical Research Unit for Dementia at South London & Maudsley NHS Foundation, London, United Kingdom
| | - Thomas K Karikari
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Juan Lantero Rodríguez
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anniina Snellman
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Turku PET Centre, University of Turku, Turku, Finland
| | - Marc Suárez-Calvet
- Barcelonaßeta Brain Research Center, Pasqual Maragall Foundation. Barcelona, Spain.,Hospital del Mar Medical Research Institute, Barcelona, Spain.,Servei de Neurologia, Hospital del Mar, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable, Madrid, Spain
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom.,UK Dementia Research Institute at University College London, London, United Kingdom
| | - Michael Schöll
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden.,Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
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16
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Jardel A, Hopes L, Malaplate C, Roch V, Manca C, Jonveaux TR, Verger A. Prognostic Impact of 18-F-Florbetaben Amyloid PET Imaging in Patients with Isolated Increases in Cerebrospinal Fluid Phospho-Tau Biomarkers: A Longitudinal Study. J Alzheimers Dis 2021; 80:1389-1394. [PMID: 33682716 DOI: 10.3233/jad-201435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This longitudinal study evaluates the prognostic impact of amyloid PET in patients suspected of Alzheimer's disease and presenting with isolated cerebrospinal fluid (CSF) increases in P-Tau proteins (NCT02556502). The rate of conversion, based on the DSM-5 criteria and all collected data (average follow-up of 39.2±13.2 months), was determined by a panel of experts blinded to the PET results and was 75%(6/8) for positive and 35%(6/17) for negative baseline amyloid PET. In this population with isolated CSF increases in P-Tau, a positive baseline amyloid PET was associated with greater than twice the proportion of dementia conversions within the following three years.
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Affiliation(s)
- Amory Jardel
- Department of Neurology and Geriatrics, CHRU-Nancy, Lorraine University, Nancy, France
| | - Lucie Hopes
- Department of Neurology and Geriatrics, CHRU-Nancy, Lorraine University, Nancy, France
| | - Catherine Malaplate
- Molecular Biology and Nutrition, CRB, Department of Biochemistry, CHRU-Nancy, Lorraine University, Nancy, France
| | - Véronique Roch
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, CHRU-Nancy, Lorraine University, Nancy, France
| | - Chloé Manca
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, CHRU-Nancy, Lorraine University, Nancy, France
| | | | - Antoine Verger
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, CHRU-Nancy, Lorraine University, Nancy, France.,IADI, INSERM, Lorraine University, Nancy, France
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17
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Ye LQ, Gao PR, Zhang YB, Cheng HR, Tao QQ, Wu ZY, Li HL. Application of Cerebrospinal Fluid AT(N) Framework on the Diagnosis of AD and Related Cognitive Disorders in Chinese Han Population. Clin Interv Aging 2021; 16:311-323. [PMID: 33654388 PMCID: PMC7910151 DOI: 10.2147/cia.s294756] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/21/2021] [Indexed: 11/23/2022] Open
Abstract
Background Studies concerning the impact of the AT(N) framework on diagnostic capability in the dementia population are lacking. We aimed to explore the diagnostic application of CSF AT(N) framework in clinical routines of Alzheimer's disease (AD) as well as differential diagnosis of other cognitive diseases in the Chinese Han population. Patients and Methods A total of 137 patients with cognitive disorders received CSF tests of Aβ42, t-tau and p-tau181. Their CSF biomarker results were categorized and interpreted by the AT(N) framework. Neurologists provided a diagnosis both pre- and post-CSF biomarker disclosure with corresponding diagnostic confidence. Results The total initial diagnosis included 79 patients with AD and 58 patients with non-AD (NAD). The results of CSF biomarkers led to a diagnostic change of 28% in the cohort. Approximately 81.5% (n=53) of 65 patients whose CSF biomarker showed an underlying AD pathology were finally diagnosed as AD, with an increase of 17.5% in diagnostic confidence. Thirty-seven CSF results indicating NAD pathologic changes contributed to an exclusion of AD in 56.8% (n=21) of the patients along with a modest increase of 9.8% in average confidence. Thirty-five patients with normal CSF biomarkers maintained the diagnosis of NAD in 68.6% (n=24) of the group, leading to a slight elevation of 7.6% in confidence. Conclusion We found that the presence of amyloid pathology (A+) is contributable to diagnosing AD and improving confidence. On occasion of negative amyloid pathology (A-), with or without tau pathology, gaining uncertainty of the primary AD diagnosis would diminish the corresponding confidence. To the best of our knowledge, this is the first study performed in the Chinese Han population with cognitive disorders that explores the clinical capability of CSF AT(N) framework in a quantitative way.
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Affiliation(s)
- Ling-Qi Ye
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,Department of Rehabilitation Medicine and Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, People's Republic of China
| | - Pei-Rong Gao
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Yan-Bin Zhang
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,Department of Neurology and Institute of Neurology in First Affiliated Hospital, Fujian Medical University, Fuzhou, People's Republic of China
| | - Hong-Rong Cheng
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,Department of Neurology in Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, People's Republic of China
| | - Qing-Qing Tao
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Zhi-Ying Wu
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Hong-Lei Li
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
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18
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Outcomes of clinical utility in amyloid-PET studies: state of art and future perspectives. Eur J Nucl Med Mol Imaging 2021; 48:2157-2168. [PMID: 33594474 PMCID: PMC8175294 DOI: 10.1007/s00259-020-05187-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/28/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE To review how outcomes of clinical utility are operationalized in current amyloid-PET validation studies, to prepare for formal assessment of clinical utility of amyloid-PET-based diagnosis. METHODS Systematic review of amyloid-PET research studies published up to April 2020 that included outcomes of clinical utility. We extracted and analyzed (a) outcome categories, (b) their definition, and (c) their methods of assessment. RESULTS Thirty-two studies were eligible. (a) Outcome categories were clinician-centered (found in 25/32 studies, 78%), patient-/caregiver-centered (in 9/32 studies, 28%), and health economics-centered (5/32, 16%). (b) Definition: Outcomes were mainly defined by clinical researchers; only the ABIDE study expressly included stakeholders in group discussions. Clinician-centered outcomes mainly consisted of incremental diagnostic value (25/32, 78%) and change in patient management (17/32, 53%); patient-/caregiver-centered outcomes considered distress after amyloid-pet-based diagnosis disclosure (8/32, 25%), including quantified burden of procedure for patients' outcomes (n = 8) (1/8, 12.5%), impact of disclosure of results (6/8, 75%), and psychological implications of biomarker-based diagnosis (75%); and health economics outcomes focused on costs to achieve a high-confidence etiological diagnosis (5/32, 16%) and impact on quality of life (1/32, 3%). (c) Assessment: all outcome categories were operationalized inconsistently across studies, employing 26 different tools without formal rationale for selection. CONCLUSION Current studies validating amyloid-PET already assessed outcomes for clinical utility, although non-clinician-based outcomes were inconsistent. A wider participation of stakeholders may help produce a more thorough and systematic definition and assessment of outcomes of clinical utility and help collect evidence informing decisions on reimbursement of amyloid-PET.
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19
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Reimand J, Groot C, Teunissen CE, Windhorst AD, Boellaard R, Barkhof F, Nazarenko S, van der Flier WM, van Berckel BNM, Scheltens P, Ossenkoppele R, Bouwman F. Why Is Amyloid-β PET Requested After Performing CSF Biomarkers? J Alzheimers Dis 2020; 73:559-569. [PMID: 31796674 PMCID: PMC7081099 DOI: 10.3233/jad-190836] [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] [Indexed: 01/08/2023]
Abstract
BACKGROUND Amyloid-β positron emission tomography (PET) and cerebrospinal fluid (CSF) Aβ42 are considered interchangeable for clinical diagnosis of Alzheimer's disease. OBJECTIVE To explore the clinical reasoning for requesting additional amyloid-β PET after performing CSF biomarkers. METHODS We retrospectively identified 72 memory clinic patients who underwent amyloid-β PET after CSF biomarkers analysis for clinical diagnostic evaluation between 2011 and 2019. We performed patient chart reviews to identify factors which led to additional amyloid-β PET. Additionally, we assessed accordance with appropriate-use-criteria (AUC) for amyloid-β PET. RESULTS Mean patient age was 62.0 (SD = 8.1) and mean Mini-Mental State Exam score was 23.6 (SD = 3.8). CSF analysis conflicting with the clinical diagnosis was the most frequent reason for requesting an amyloid-β PET scan (n = 53, 74%), followed by incongruent MRI (n = 16, 22%), unusual clinical presentation (n = 11, 15%) and young age (n = 8, 11%). An amyloid-β PET scan was rarely (n = 5, 7%) requested in patients with a CSF Aβ+/tau+ status. Fifteen (47%) patients with a post-PET diagnosis of AD had a predominantly non-amnestic presentation. In n = 11 (15%) cases, the reason that the clinician requested amyloid-β was not covered by AUC. This happened most often (n = 7) when previous CSF analysis did not support current clinical diagnosis, which led to requesting amyloid-β PET. CONCLUSION In this single-center study, the main reason for requesting an amyloid-β PET scan after performing CSF biomarkers was the occurrence of a mismatch between the primary clinical diagnosis and CSF Aβ/tau results.
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Affiliation(s)
- Juhan Reimand
- Department of Neurology & Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands.,Department of Health Technologies, Tallinn University of Technology, Tallinn, Estonia.,Radiology Centre, North Estonia Medical Centre, Tallinn, Estonia
| | - Colin Groot
- Department of Neurology & Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Albert D Windhorst
- Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ronald Boellaard
- Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Centre for Medical Image Computing, Medical Physics and Biomedical Engineering, UCL, United Kingdom
| | - Sergei Nazarenko
- Department of Health Technologies, Tallinn University of Technology, Tallinn, Estonia
| | - Wiesje M van der Flier
- Department of Neurology & Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands.,Department of Epidemiology & Biostatistics, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Bart N M van Berckel
- Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Philip Scheltens
- Department of Neurology & Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Rik Ossenkoppele
- Department of Neurology & Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands.,Clinical Memory Research Unit, Lund University, Lund, Sweden
| | - Femke Bouwman
- Department of Neurology & Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
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20
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Carrera-Muñoz I, Triguero-Cueva L, Romero-Fábrega JC, Triviño-Ibáñez EM, Vilchez-Carrillo R, Carnero-Pardo C, Gómez-Río M. PET-Amyloid After Inconclusive Cerebrospinal Fluid Biomarkers in Clinical Practice. Is it Necessary to Duplicate Procedures? Curr Alzheimer Res 2020; 17:698-708. [PMID: 33167840 DOI: 10.2174/1567205017666201109092637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 09/01/2020] [Accepted: 10/13/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION In the absence of a gold standard for in vivo Alzheimer disease (AD) diagnosis, AD biomarkers such as cerebrospinal fluid biomarkers (CSF-B) and PET-Amyloid are considered diagnostically useful in clinical practice guidelines and have consensual appropriate use criteria (AUC). However, little evidence has been published on their utilization in the clinical setting or on approaches to mismatched results. The objective of this work was to evaluate the use of AD biomarkers in clinical practice, focusing on the implementation of PET-Amyloid in cases of inconclusive CSF-B. METHODS This naturalistic, ambispective case series included patients fulfilling AUC for CSF-B and PET-Amyloid whose CSF-B results were non-diagnostic (target population), analyzing the diagnostic certainty, the treatment approach, and the relationship between CSF-B and PET-Amyloid results. RESULTS Out of 2373 eligible patients, AD biomarkers were studied in 417 (17.6%), most frequently due to cognitive impairment in under 65-year-olds, using CSF-B in 311 patients and PET-Amyloid in 150. CSF-B results were non-diagnostic for 44 patients (52.3% male; aged 60.9±6.6 years), who then underwent PET-Amyloid study, which was positive in 31. A 'k' coefficient of 0.108 was obtained between CSF-B and PET-amyloid (54.5% concordance). In multivariate regression analysis, Aβ42 was the only significant predictor (p= 0.018) of a positive PET-Amyloid result. In the target population, PETAmyloid increased diagnostic confidence by 53.7% (p <0.001) and modified the therapeutic approach in 36.4% of cases. CONCLUSION These findings support the duplication of AD biomarkers and demonstrate that the implementation of PET-Amyloid provides an early and certain diagnosis to guide appropriate treatment.
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Affiliation(s)
- Ismael Carrera-Muñoz
- Department of Neurology, Virgen de las Nieves University Hospital, Cognitive and Behavioral Neurology Unit,
Granada, Spain
| | - Lucía Triguero-Cueva
- Department of Neurology, Virgen de las Nieves University Hospital, Cognitive and Behavioral Neurology Unit,
Granada, Spain
| | - Juan C Romero-Fábrega
- Department of Neurology, Virgen de las Nieves University Hospital, Cognitive and Behavioral Neurology Unit,
Granada, Spain
| | - Eva M Triviño-Ibáñez
- Department of Nuclear Medicine, Virgen de las Nieves University Hospital, Granada, Spain
| | - Rosa Vilchez-Carrillo
- Department of Neurology, Virgen de las Nieves University Hospital, Cognitive and Behavioral Neurology Unit,
Granada, Spain
| | - Cristóbal Carnero-Pardo
- Fidyan Neurocenter, Granada, Spain,IBS Granada Bio-Health Research Institute, Granada, Spain
| | - Manuel Gómez-Río
- Department of Neurology, Virgen de las Nieves University Hospital, Cognitive and Behavioral Neurology Unit,
Granada, Spain,Department of Nuclear Medicine, Virgen de las Nieves University Hospital, Granada, Spain
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21
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Chételat G, Arbizu J, Barthel H, Garibotto V, Law I, Morbelli S, van de Giessen E, Agosta F, Barkhof F, Brooks DJ, Carrillo MC, Dubois B, Fjell AM, Frisoni GB, Hansson O, Herholz K, Hutton BF, Jack CR, Lammertsma AA, Landau SM, Minoshima S, Nobili F, Nordberg A, Ossenkoppele R, Oyen WJG, Perani D, Rabinovici GD, Scheltens P, Villemagne VL, Zetterberg H, Drzezga A. Amyloid-PET and 18F-FDG-PET in the diagnostic investigation of Alzheimer's disease and other dementias. Lancet Neurol 2020; 19:951-962. [PMID: 33098804 DOI: 10.1016/s1474-4422(20)30314-8] [Citation(s) in RCA: 220] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 07/22/2020] [Accepted: 08/06/2020] [Indexed: 12/14/2022]
Abstract
Various biomarkers are available to support the diagnosis of neurodegenerative diseases in clinical and research settings. Among the molecular imaging biomarkers, amyloid-PET, which assesses brain amyloid deposition, and 18F-fluorodeoxyglucose (18F-FDG) PET, which assesses glucose metabolism, provide valuable and complementary information. However, uncertainty remains regarding the optimal timepoint, combination, and an order in which these PET biomarkers should be used in diagnostic evaluations because conclusive evidence is missing. Following an expert panel discussion, we reached an agreement on the specific use of the individual biomarkers, based on available evidence and clinical expertise. We propose a diagnostic algorithm with optimal timepoints for these PET biomarkers, also taking into account evidence from other biomarkers, for early and differential diagnosis of neurodegenerative diseases that can lead to dementia. We propose three main diagnostic pathways with distinct biomarker sequences, in which amyloid-PET and 18F-FDG-PET are placed at different positions in the order of diagnostic evaluations, depending on clinical presentation. We hope that this algorithm can support diagnostic decision making in specialist clinical settings with access to these biomarkers and might stimulate further research towards optimal diagnostic strategies.
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Affiliation(s)
- Gaël Chételat
- Normandie Université, Université de Caen, Institut National de la Santé et de la Recherche Médicale, Unité 1237, Groupement d'Intérêt Public Cyceron, Caen, France.
| | - Javier Arbizu
- Department of Nuclear Medicine, University of Navarra, Clinica Universidad de Navarra, Pamplona, Spain
| | - Henryk Barthel
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Valentina Garibotto
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals and NIMTlab, Geneva University, Geneva, Switzerland
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Silvia Morbelli
- Nuclear Medicine Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico San Martino, Genova, Italy
| | - Elsmarieke van de Giessen
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Federica Agosta
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, Istituto di Ricovero e Cura a Carattere, San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Institutes of Neurology and Healthcare Engineering, University College London, London, UK
| | - David J Brooks
- Institute of Neuroscience, Newcastle University, Newcastle, UK; Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | | | - Bruno Dubois
- Centre des Maladies Cognitives et Comportementales, University Hospital of Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne-Université, Paris, France
| | - Anders M Fjell
- Center for Lifespan Changes in Brain and Cognition, Department of Psychology, University of Oslo, Norway, Oslo; Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Giovanni B Frisoni
- Memory Clinic, Department of Rehabilitation and Geriatrics, Geneva University and University Hospitals, Geneva, Switzerland
| | - Oskar Hansson
- Clinical Memory Research Unit, Lund University, Malmö, Sweden; Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Karl Herholz
- Wolfson Molecular Imaging Centre, Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Brian F Hutton
- Institute of Nuclear Medicine, University College London, London, UK
| | | | - Adriaan A Lammertsma
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Susan M Landau
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, USA
| | - Satoshi Minoshima
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Flavio Nobili
- UO Clinica Neurologica, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico San Martino, Genova, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Child and Mother Health, University of Genoa, Genova, Italy
| | - Agneta Nordberg
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
| | - Rik Ossenkoppele
- Department of Neurology, Alzheimer Center, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Clinical Memory Research Unit, Lund University, Lund, Sweden
| | - Wim J G Oyen
- Humanitas University and Humanitas Clinical and Research Center, Department of Nuclear Medicine, Milan, Italy; Rijnstate, Department of Radiology and Nuclear Medicine, Arnhem, Netherlands; Radboud UMC, Department of Radiology and Nuclear Medicine, Nijmegen, Netherlands
| | - Daniela Perani
- Vita-Salute San Raffaele University, Nuclear Medicine Unit, San Raffaele Hospital, Division of Neuroscience San Raffaele Scientific Institute, Milan, Italy
| | - Gil D Rabinovici
- Departments of Neurology, Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Philip Scheltens
- Department of Neurology, Alzheimer Center, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Victor L Villemagne
- Department of Molecular Imaging & Therapy, Austin Health, Department of Medicine, University of Melbourne, Austin Health, Heidelberg, VIC, Australia; School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Henrik Zetterberg
- Department of Neurodegenerative Disease, Institute of Neurology, University College London, London, UK; Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; UK Dementia Research Institute at University College London, London, UK
| | - Alexander Drzezga
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; German Center for Neurodegenerative Diseases, Bonn-Cologne, Germany; Institute of Neuroscience and Medicine, Molecular Organization of the Brain, Forschungszentrum Jülich, Germany
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22
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Manca C, Hopes L, Kearney-Schwartz A, Roch V, Karcher G, Baumann C, Marie PY, Malaplate-Armand C, Jonveaux TR, Verger A. Assessment of 18F-Florbetaben Amyloid PET Imaging in Patients with Suspected Alzheimer's Disease and Isolated Increase in Cerebrospinal Fluid Tau Proteins. J Alzheimers Dis 2020; 68:1061-1069. [PMID: 30883358 DOI: 10.3233/jad-181146] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND/OBJECTIVE The aim of this study was to assess, in routine, the rates with which an amyloid deposition was documented by 18F-florbetaben PET in patients with suspected Alzheimer's disease (AD) but with isolated increases in cerebrospinal fluid (CSF) tau-protein concentrations, and the subsequent impact of these PET results on medical management. METHODS This prospective study included 34 patients with mild neurocognitive disorders (MND) and suspected AD (73±9 years, 16 women) and with abnormal CSF concentrations in total-tau (T-tau) and/or phosphorylated-tau (P-tau) proteins but normal Aβ42 concentration and Aβ42/Aβ40 ratio. These patients were referred to 8F-florbetaben PET from which the PET-related changes in the confidence for AD diagnosis (low, intermediate, or high) and treatments were reported. RESULTS The PET examinations were positive for amyloid deposition (brain amyloid plaque load, BAPL score >1) in none of the 9 patients with an increase in only T-tau proteins and in 8 among the 25 (32%) with an increase in P-tau proteins (one BAPL score of 2 and seven BAPL scores of 3). Knowledge of the PET results was associated with subsequent changes in diagnostic confidence in 44% of patients (15/34) and in the intention-to-treat with a cholinesterase inhibitor drug in 18% (6/34). CONCLUSION In patients with suspected AD and isolated increase in CSF tau protein concentrations, an amyloid deposition is documented by 18F-florbetaben PET in as much as one third of cases when the concentration of P-tau is abnormal, and PET results are associated with significant further changes in medical management.
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Affiliation(s)
- Chloé Manca
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, CHRU-Nancy, Lorraine University, Nancy, France
| | - Lucie Hopes
- Department of Neurology, CHRU-Nancy, Lorraine University, Nancy, France
| | | | - Véronique Roch
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, CHRU-Nancy, Lorraine University, Nancy, France
| | - Gilles Karcher
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, CHRU-Nancy, Lorraine University, Nancy, France
| | - Cédric Baumann
- CHRU-Nancy, Methodological and Biostatistical Support Unit, Platform of Clinical Research Support PARC, Nancy, France
| | - Pierre-Yves Marie
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, CHRU-Nancy, Lorraine University, Nancy, France.,INSERM, Lorraine University, DCAC, Nancy, INSERM U1116, France
| | - Catherine Malaplate-Armand
- Department of Biochemistry, CHRU-Nancy, Lorraine University, Molecular Biology and Nutrition, Nancy, France
| | | | - Antoine Verger
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, CHRU-Nancy, Lorraine University, Nancy, France.,IADI, INSERM, Lorraine University, Nancy, INSERM U1254, France
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23
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Hattori N, Sherwin P, Farrar G. Initial Physician Experience with [ 18F]Flutemetamol Amyloid PET Imaging Following Availability for Routine Clinical Use in Japan. J Alzheimers Dis Rep 2020; 4:165-174. [PMID: 32715277 PMCID: PMC7369136 DOI: 10.3233/adr-190150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Brain amyloid is a neuropathological hallmark of Alzheimer’s disease (AD). By visualizing brain amyloid, positron emission tomography (PET) may influence the diagnostic assessment and management of patients with cognitive impairment. Objective: As part of a Japanese post-approval study to measure the safety of [18F]flutemetamol PET, the association of amyloid PET results with changes in diagnosis and diagnostic confidence was assessed. Methods: Fifty-seven subjects were imaged for amyloid PET using [18F]flutemetamol at a single Japanese memory clinic. The cognitive diagnosis and referring physician’s confidence in the diagnosis were recorded before and after availability of PET results. Imaging started approximately 90 minutes after [18F]flutemetamol administration with approximately 185 MBq injected. PET images were acquired for 30 minutes. Results: Amyloid PET imaging led to change in diagnosis in 15/44 clinical subjects (34%). Mean diagnostic confidence increased by approximately 20%, from 73% pre-scan to 93% post-scan, and this rise was fairly consistent across the main patient subgroups (mild cognitive impairment, AD, and non-AD) irrespective of the pre-scan diagnosis and scan result. Conclusion: The study examined the utility of amyloid PET imaging in a Japanese clinical cohort and highlighted the use of an etiological diagnosis in the presence of the amyloid scan. [18F]Flutemetamol PET led to a change in diagnosis in over 30% of cases and to an increase in diagnostic confidence by approximately 20% consistent with other reports.
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24
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Padovani A, Benussi A, Cotelli MS, Ferrari C, Cantoni V, Dell'Era V, Turrone R, Paghera B, Borroni B. Transcranial magnetic stimulation and amyloid markers in mild cognitive impairment: impact on diagnostic confidence and diagnostic accuracy. ALZHEIMERS RESEARCH & THERAPY 2019; 11:95. [PMID: 31787103 PMCID: PMC6886207 DOI: 10.1186/s13195-019-0555-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 11/08/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND The development of diagnostic tools capable of accurately identifying the pathophysiology of mild cognitive impairment (MCI) has become a crucial target considering the claim that disease-modifying treatments should be administered as early as possible in the disease course. Transcranial magnetic stimulation (TMS) protocols have demonstrated analytical validity in discriminating different forms of dementia; however, its value in daily clinical practice in MCI subjects is still unknown. OBJECTIVE To evaluate the clinical value of TMS compared to amyloid markers on diagnostic confidence and accuracy in MCI subjects, considering clinicians' expertise. METHODS One hundred seven MCI subjects were included and classified as MCI-Alzheimer disease (MCI-AD), MCI-frontotemporal dementia (MCI-FTD), MCI-dementia with Lewy bodies (MCI-DLB), or MCI-other in a three-step process based on (i) demographic, clinical, and neuropsychological evaluation (clinical work-up); (ii) clinical work-up PLUS amyloidosis markers or clinical work-up PLUS TMS measures; and (iii) clinical work-up PLUS both markers. Two blinded neurologists with different clinical expertise were asked to express a diagnostic confidence for each MCI subgroup, and ROC curve analyses were performed at each step. RESULTS The addition of TMS markers to clinical work-up significantly increased the diagnostic confidence for MCI-AD (p = 0.003), MCI-FTD (p = 0.044), and MCI-DLB (p = 0.033) compared to clinical work-up alone, but not for MCI-other (p > 0.05). No significant differences between the add-on effect of TMS and the add-on effect of amyloid markers to clinical work-up were observed (p > 0.732), while the diagnostic confidence further increased when both markers were available. The greater the clinical expertise, the greater the flexibility in considering alternative diagnosis, and the greater the ability to modify diagnostic confidence with TMS and amyloid markers. CONCLUSIONS TMS in addition to routine clinical assessment in MCI subjects has a significant effect on diagnostic accuracy and confidence, comparable to well-established biomarkers of amyloidosis.
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Affiliation(s)
- Alessandro Padovani
- Centre for Neurodegenerative Disorders, Neurology Unit, Department of Clinical and Experimental Sciences, Clinica Neurologica, University of Brescia, P.le Spedali Civili, 1, 25100, Brescia, Italy
| | - Alberto Benussi
- Centre for Neurodegenerative Disorders, Neurology Unit, Department of Clinical and Experimental Sciences, Clinica Neurologica, University of Brescia, P.le Spedali Civili, 1, 25100, Brescia, Italy
| | | | - Clarissa Ferrari
- Service of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Valentina Cantoni
- Centre for Neurodegenerative Disorders, Neurology Unit, Department of Clinical and Experimental Sciences, Clinica Neurologica, University of Brescia, P.le Spedali Civili, 1, 25100, Brescia, Italy.,Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Valentina Dell'Era
- Centre for Neurodegenerative Disorders, Neurology Unit, Department of Clinical and Experimental Sciences, Clinica Neurologica, University of Brescia, P.le Spedali Civili, 1, 25100, Brescia, Italy
| | - Rosanna Turrone
- Centre for Neurodegenerative Disorders, Neurology Unit, Department of Clinical and Experimental Sciences, Clinica Neurologica, University of Brescia, P.le Spedali Civili, 1, 25100, Brescia, Italy
| | - Barbara Paghera
- Nuclear Medicine Unit, Spedali Civili Brescia, Brescia, Italy
| | - Barbara Borroni
- Centre for Neurodegenerative Disorders, Neurology Unit, Department of Clinical and Experimental Sciences, Clinica Neurologica, University of Brescia, P.le Spedali Civili, 1, 25100, Brescia, Italy.
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25
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Shea YF, Barker W, Greig-Gusto MT, Loewenstein DA, DeKosky ST, Duara R. Utility of Amyloid PET Scans in the Evaluation of Patients Presenting with Diverse Cognitive Complaints. J Alzheimers Dis 2019; 66:1599-1608. [PMID: 30475766 DOI: 10.3233/jad-180683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The impact of amyloid positron emission tomography (Aβ-PET) in a "real-world" memory disorders clinic remains poorly studied. OBJECTIVE We studied the impact of Aβ-PET in diagnosis and management in the memory clinic and factors making the most impact in diagnosis and management. METHODS We studied 102 patients who had presented at a memory disorders clinic (the Wien Center for Alzheimer's Disease and Memory Disorders, Miami Beach, FL) and had a diagnostic work-up for cognitive complaints, including Aβ-PET scans. RESULTS Following Aβ-PET, changes were made in diagnosis (37.3%), in specific treatments for Alzheimer's disease (26.5%) and in psychiatric treatments (25.5%). The agreement between diagnosis pre-Aβ-PET versus post-Aβ-PET diagnosis was only fair, with a Cohen's kappa of 0.23 (95% CI 0-0.42). Patients with MRI findings suggestive of AD (medial temporal and/or parietal atrophy) were more frequently amyloid positive than amyloid negative (66.2% versus 33.8%, p = 0.04). Among patients with atypical clinical features for AD, but with MRI findings suggestive of AD, an amyloid negative PET scan had a greater impact than an amyloid positive PET scan on diagnosis (84.2% versus 17.1%, p < 0.001), management (84.2% versus 40%, p < 0.01) and discussion of results and advice on lifestyle (73.7% versus 22.9%, p < 0.001). CONCLUSIONS We conclude that MRI features suggestive of AD predict a positive amyloid PET scan. However, among those with MRI features suggestive of AD but with atypical clinical features of AD, the clinical impact on diagnosis and management is greater for an amyloid negative than an amyloid positive Aβ-PET scans.
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Affiliation(s)
- Yat-Fung Shea
- Wien Center for Alzheimer's Disease & Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL, USA.,Department of Medicine, LKS Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Warren Barker
- Wien Center for Alzheimer's Disease & Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Maria T Greig-Gusto
- Wien Center for Alzheimer's Disease & Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - David A Loewenstein
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, FL, USA
| | - Steven T DeKosky
- Department of Neurology, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Ranjan Duara
- Wien Center for Alzheimer's Disease & Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL, USA
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Sharafi SM, Sylvestre JP, Chevrefils C, Soucy JP, Beaulieu S, Pascoal TA, Arbour JD, Rhéaume MA, Robillard A, Chayer C, Rosa-Neto P, Mathotaarachchi SS, Nasreddine ZS, Gauthier S, Lesage F. Vascular retinal biomarkers improves the detection of the likely cerebral amyloid status from hyperspectral retinal images. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2019; 5:610-617. [PMID: 31650017 PMCID: PMC6804547 DOI: 10.1016/j.trci.2019.09.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction This study investigates the relationship between retinal image features and β-amyloid (Aβ) burden in the brain with the aim of developing a noninvasive method to predict the deposition of Aβ in the brain of patients with Alzheimer's disease. Methods Retinal images from 20 cognitively impaired and 26 cognitively unimpaired cases were acquired (3 images per subject) using a hyperspectral retinal camera. The cerebral amyloid status was determined from binary reads by a panel of 3 expert raters on 18F-florbetaben positron-emission tomography (PET) studies. Image features from the hyperspectral retinal images were calculated, including vessels tortuosity and diameter and spatial-spectral texture measures in different retinal anatomical regions. Results Retinal venules of amyloid-positive subjects (Aβ+) showed a higher mean tortuosity compared with the amyloid-negative (Aβ−) subjects. Arteriolar diameter of Aβ+ subjects was found to be higher than the Aβ− subjects in a zone adjacent to the optical nerve head. Furthermore, a significant difference between texture measures built over retinal arterioles and their adjacent regions were observed in Aβ+ subjects when compared with the Aβ−. A classifier was trained to automatically discriminate subjects combining the extracted features. The classifier could discern Aβ+ subjects from Aβ− subjects with an accuracy of 85%. Discussion Significant differences in texture measures were observed in the spectral range 450 to 550 nm which is known as the spectral region known to be affected by scattering from amyloid aggregates in the retina. This study suggests that the inclusion of metrics related to the retinal vasculature and tissue-related textures extracted from vessels and surrounding regions could improve the discrimination performance of the cerebral amyloid status.
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Affiliation(s)
| | | | | | - Jean-Paul Soucy
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Sylvain Beaulieu
- Département de médecine nucléaire, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Tharick A Pascoal
- Translational Neuroimaging Laboratory, McGill Centre for Studies in Aging, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | | | | | - Alain Robillard
- Département de psychiatrie, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Céline Chayer
- Département de psychiatrie, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Pedro Rosa-Neto
- Translational Neuroimaging Laboratory, McGill Centre for Studies in Aging Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Sulantha S Mathotaarachchi
- Translational Neuroimaging Laboratory, McGill Centre for Studies in Aging Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | | | - Serge Gauthier
- Alzheimer's Disease Research Unit, The McGill University Research Centre for Studies in Aging, Montreal, Quebec, Canada
| | - Frédéric Lesage
- Genie Electrique, Polytechnique Montreal, Montreal, Quebec, Canada.,Research Center, Montreal Heart Institute, Montreal, Quebec, Canada
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27
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Ramusino MC, Garibotto V, Bacchin R, Altomare D, Dodich A, Assal F, Mendes A, Costa A, Tinazzi M, Morbelli SD, Bauckneht M, Picco A, Dottorini ME, Tranfaglia C, Farotti L, Salvadori N, Moretti D, Savelli G, Tarallo A, Nobili F, Parapini M, Cavaliere C, Salvatore E, Salvatore M, Boccardi M, Frisoni GB. Incremental value of amyloid-PET versus CSF in the diagnosis of Alzheimer's disease. Eur J Nucl Med Mol Imaging 2019; 47:270-280. [PMID: 31388720 DOI: 10.1007/s00259-019-04466-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/26/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To compare the incremental diagnostic value of amyloid-PET and CSF (Aβ42, tau, and phospho-tau) in AD diagnosis in patients with mild cognitive impairment (MCI) or mild dementia, in order to improve the definition of diagnostic algorithm. METHODS Two independent dementia experts provided etiological diagnosis and relative diagnostic confidence in 71 patients on 3 rounds, based on (1) clinical, neuropsychological, and structural MRI information alone; (2) adding one biomarker (CSF amyloid and tau levels or amyloid-PET with a balanced randomized design); and (3) adding the other biomarker. RESULTS Among patients with a pre-biomarker diagnosis of AD, negative PET induced significantly more diagnostic changes than amyloid-negative CSF at both rounds 2 (CSF 67%, PET 100%, P = 0.028) and 3 (CSF 0%; PET 78%, P < 0.001); PET induced a diagnostic confidence increase significantly higher than CSF on both rounds 2 and 3. CONCLUSIONS Amyloid-PET should be prioritized over CSF biomarkers in the diagnostic workup of patients investigated for suspected AD, as it provides greater changes in diagnosis and diagnostic confidence. TRIAL REGISTRATION EudraCT no.: 2014-005389-31.
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Affiliation(s)
- Matteo Cotta Ramusino
- Memory Clinic and LANVIE -Laboratory of Neuroimaging of Aging, University Hospitals and University of Geneva, Chemin du Petit Bel-Air 2, Bâtiment Voirons, CH1225, Geneva, Switzerland. .,Center for Cognitive and Behavioral Disorders, IRCCS Mondino Foundation and Dept of Brain and Behavior, University of Pavia, 27100, Pavia, Italy.
| | - Valentina Garibotto
- NIMTlab, Neuroimaging and Innovative Molecular Tracers Laboratory, University of Geneva, CH1205, Geneva, Switzerland.,Division of Nuclear Medicine, Geneva University Hospitals, CH1205, Geneva, Switzerland
| | - Ruggero Bacchin
- Memory Clinic and LANVIE -Laboratory of Neuroimaging of Aging, University Hospitals and University of Geneva, Chemin du Petit Bel-Air 2, Bâtiment Voirons, CH1225, Geneva, Switzerland.,Dept of Neurosciences, Biomedicine and Movement Sciences, Section of Neurology, University of Verona, 34134, Verona, Italy
| | - Daniele Altomare
- Memory Clinic and LANVIE -Laboratory of Neuroimaging of Aging, University Hospitals and University of Geneva, Chemin du Petit Bel-Air 2, Bâtiment Voirons, CH1225, Geneva, Switzerland
| | - Alessandra Dodich
- NIMTlab, Neuroimaging and Innovative Molecular Tracers Laboratory, University of Geneva, CH1205, Geneva, Switzerland
| | - Frederic Assal
- Memory Clinic and LANVIE -Laboratory of Neuroimaging of Aging, University Hospitals and University of Geneva, Chemin du Petit Bel-Air 2, Bâtiment Voirons, CH1225, Geneva, Switzerland
| | - Aline Mendes
- Memory Clinic and LANVIE -Laboratory of Neuroimaging of Aging, University Hospitals and University of Geneva, Chemin du Petit Bel-Air 2, Bâtiment Voirons, CH1225, Geneva, Switzerland
| | - Alfredo Costa
- Center for Cognitive and Behavioral Disorders, IRCCS Mondino Foundation and Dept of Brain and Behavior, University of Pavia, 27100, Pavia, Italy
| | - Michele Tinazzi
- Dept of Neurosciences, Biomedicine and Movement Sciences, Section of Neurology, University of Verona, 34134, Verona, Italy
| | - Silvia D Morbelli
- Nuclear Medicine, Dept of Health Sciences (DISSAL), University of Genoa and IRCCS AOU San Martino-IST, 16132, Genoa, Italy
| | - Matteo Bauckneht
- Nuclear Medicine, Dept of Health Sciences (DISSAL), University of Genoa and IRCCS AOU San Martino-IST, 16132, Genoa, Italy
| | - Agnese Picco
- Clinical Neurology, Dept. of Neuroscience (DINOGMI), University of Genoa, 16126, Genoa, Italy
| | - Massimo E Dottorini
- Nuclear Medicine Division, "S. Maria della Misericordia" Hospital, 06129, Perugia, Italy
| | - Cristina Tranfaglia
- Nuclear Medicine Division, "S. Maria della Misericordia" Hospital, 06129, Perugia, Italy
| | - Lucia Farotti
- Center for Memory Disturbances, Laboratory of Clinical Neurochemistry, University of Perugia, 06123, Perugia, Italy
| | - Nicola Salvadori
- Center for Memory Disturbances, Laboratory of Clinical Neurochemistry, University of Perugia, 06123, Perugia, Italy
| | - Davide Moretti
- Alzheimer's Disease Operative Unit, IRCCS S, Giovanni di Dio Fatebenefratelli, 25125, Brescia, Italy
| | - Giordano Savelli
- Nuclear Medicine Division, Fondazione Poliambulanza Istituto Ospedaliero, 25124, Brescia, Italy
| | - Anna Tarallo
- LANE-Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS San Giovanni di Dio Fatebenefratelli, 25125, Brescia, Italy
| | - Flavio Nobili
- Clinical Neurology, Dept. of Neuroscience (DINOGMI), University of Genoa, 16126, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Maura Parapini
- Memory Clinic and LANVIE -Laboratory of Neuroimaging of Aging, University Hospitals and University of Geneva, Chemin du Petit Bel-Air 2, Bâtiment Voirons, CH1225, Geneva, Switzerland
| | | | | | | | - Marina Boccardi
- Memory Clinic and LANVIE -Laboratory of Neuroimaging of Aging, University Hospitals and University of Geneva, Chemin du Petit Bel-Air 2, Bâtiment Voirons, CH1225, Geneva, Switzerland.,LANE-Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS San Giovanni di Dio Fatebenefratelli, 25125, Brescia, Italy
| | - Giovanni B Frisoni
- Memory Clinic and LANVIE -Laboratory of Neuroimaging of Aging, University Hospitals and University of Geneva, Chemin du Petit Bel-Air 2, Bâtiment Voirons, CH1225, Geneva, Switzerland
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Triviño-Ibáñez EM, Sánchez-Vañó R, Sopena-Novales P, Romero-Fábrega JC, Rodríguez-Fernández A, Carnero Pardo C, Martínez Lozano MD, Gómez-Río M. Impact of amyloid-PET in daily clinical management of patients with cognitive impairment fulfilling appropriate use criteria. Medicine (Baltimore) 2019; 98:e16509. [PMID: 31335725 PMCID: PMC6708756 DOI: 10.1097/md.0000000000016509] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To evaluate the use of amyloid-positron emission tomography (PET) in routine clinical practice, in a selected population with cognitive impairment that meets appropriate use criteria (AUC).A multicenter, observational, prospective case-series study of 211patients from 2 level-3 hospitals who fulfilled clinical AUC for amyloid-PET scan in a naturalistic setting. Certainty degree was evaluated using a 5-point Likert scale: 0 (very low probability); 1 (low probability); 2 (intermediate probability); 3 (high probability); and 4 (practically sure), before and after amyloid PET. The treatment plan was considered as cognition-specific or noncognition-specific.Amyloid-PET was positive in 118 patients (55.9%) and negative in 93 patients (44.1%). Diagnostic prescan confidence according amyloid-PET results showed that in both, negative and positive-PET subgroup, the most frequent category was intermediate probability (45.7% and 55.1%, respectively). After the amyloid-PET, the diagnostic confidence showed a very different distribution, that was, in the negative-PET group the most frequent categories are very unlikely (70.7%) and unlikely (29.3%), while in the positive-PET group were very probable (57.6%) and practically sure (39%). Only in 14/211 patients (6.6%) the result of the amyloid-PET did not influence the diagnostic confidence, while in 194 patients (93.4%), the diagnostic confidence improved significantly after amyloid-PET results. The therapeutic intention was modified in 93 patients (44.1%). Specific treatment for Alzheimer disease was started, before amyloid-PET, in 80 patients (37.9%).This naturalistic study provides evidence that the implementation of amyloid-PET is associated with a significant improvement in diagnostic confidence and has a high impact on the therapeutic management of patients with mild cognitive impairment fulfilled clinical AUC.
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Affiliation(s)
- Eva María Triviño-Ibáñez
- Department of Nuclear Medicine, Virgen de las Nieves University Hospital
- IBS, Granada Bio-Health Research Institute, Granada
| | - Raquel Sánchez-Vañó
- Department of Nuclear Medicine, La Fe University Hospital, Clinical Medicine and Public Health Doctoral Program of the University of Granada
| | | | | | - Antonio Rodríguez-Fernández
- Department of Nuclear Medicine, Virgen de las Nieves University Hospital
- IBS, Granada Bio-Health Research Institute, Granada
| | | | | | - Manuel Gómez-Río
- Department of Nuclear Medicine, Virgen de las Nieves University Hospital
- IBS, Granada Bio-Health Research Institute, Granada
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29
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Shea YF, Barker W, Greig-Gusto MT, Loewenstein DA, Duara R, DeKosky ST. Impact of Amyloid PET Imaging in the Memory Clinic: A Systematic Review and Meta-Analysis. J Alzheimers Dis 2019; 64:323-335. [PMID: 29889075 DOI: 10.3233/jad-180239] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients with cognitive impairment or dementias of uncertain etiology are frequently referred to a memory disorders specialty clinic. The impact of and role for amyloid PET imaging (Aβ-PET) may be most appropriate in this clinical setting. OBJECTIVE The primary objective of this study was to perform a systematic review and meta-analysis of the impact of Aβ-PET on etiological diagnosis and clinical management in the memory clinic setting. METHODS A search of the literature on the impact of Aβ-PET in the memory clinic setting between 1 January 2004 and 12 February 2018 was conducted. Meta-analysis using a random effects model was performed to determine the pooled estimate of the impact of Aβ-PET in the changes of diagnoses and changes in management plan. RESULTS After rigorous review, results from 13 studies were extracted, involving 1,489 patients. Meta-analysis revealed a pooled effect of change in diagnoses of 35.2% (95% CI 24.6-47.5). Sub-analyses showed that the pooled effect in change in diagnoses if Aβ-PET was used under the appropriate use criteria (AUC) or non-AUC criteria were 47.8% (95% CI 25.9-70.5) and 29.6% (95% CI: 21.5-39.3), respectively. The pooled effect of a change of diagnosis from Alzheimer's disease (AD) to non-AD and from non-AD to AD were 22.7% (95% CI: 17.1-29.5) and 25.6% (95% CI: 17.6-35.8), respectively. The pooled effect leading to a change of management was 59.6% (95% CI 39.4-77.0). CONCLUSIONS Aβ-PET has a highly significant impact on both changes in diagnosis and management among patients being seen at a specialty memory clinic.
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Affiliation(s)
- Yat-Fung Shea
- Wien Center for Alzheimer's Disease and Memory Disorder, Mount Sinai Medical Center, Miami Beach, FL, USA.,Department of Medicine, LKS Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Warren Barker
- Wien Center for Alzheimer's Disease and Memory Disorder, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Maria T Greig-Gusto
- Wien Center for Alzheimer's Disease and Memory Disorder, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - David A Loewenstein
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, FL, USA
| | - Ranjan Duara
- Wien Center for Alzheimer's Disease and Memory Disorder, Mount Sinai Medical Center, Miami Beach, FL, USA.,Departments of Neurology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL and University of Florida College of Medicine, Gainesville, FL, USA
| | - Steven T DeKosky
- Department of Neurology, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
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30
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O'Malley M, Parkes J, Stamou V, LaFontaine J, Oyebode J, Carter J. Young-onset dementia: scoping review of key pointers to diagnostic accuracy. BJPsych Open 2019; 5:e48. [PMID: 31530311 PMCID: PMC6582217 DOI: 10.1192/bjo.2019.36] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Routine psychiatric assessments tailored to older patients are often insufficient to identify the complexity of presentation in younger patients with dementia. Significant overlap between psychiatric disorders and neurodegenerative disease means that high rates of prior incorrect psychiatric diagnosis are common. Long delays to diagnosis, misdiagnosis and lack of knowledge from professionals are key concerns. No specific practice guidelines exist for diagnosis of young-onset dementia (YOD). AIMS The review evaluates the current evidence about best practice in diagnosis to guide thorough assessment of the complex presentations of YOD with a view to upskilling professionals in the field. METHOD A comprehensive search of the literature adopting a scoping review methodology was conducted regarding essential elements of diagnosis in YOD, over and above those in current diagnostic criteria for disease subtypes. This methodology was chosen because research in this area is sparse and not amenable to a traditional systematic review. RESULTS The quality of evidence identified is variable with the majority provided from expert opinion and evidence is lacking on some topics. Evidence appears weighted towards diagnosis in frontotemporal dementia and its subtypes and young-onset Alzheimer's disease. CONCLUSIONS The literature demonstrates that a clinically rigorous and systematic approach is necessary in order to avoid mis- or underdiagnosis for younger people. The advent of new disease-modifying treatments necessitates clinicians in the field to improve knowledge of new imaging techniques and genetics, with the goal of improving training and practice, and highlights the need for quality indicators and alignment of diagnostic procedures across clinical settings. DECLARATION OF INTEREST None.
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Affiliation(s)
- Mary O'Malley
- Research Assistant, Faculty of Health and Society, University of Northampton, UK
| | - Jacqueline Parkes
- Professor, Faculty of Health and Society, University of Northampton, UK
| | - Vasileios Stamou
- Research Assistant, Centre for Applied Dementia Studies, University of Bradford, UK
| | - Jenny LaFontaine
- Research Fellow, Centre for Applied Dementia Studies, University of Bradford, UK
| | - Jan Oyebode
- Centre for Applied Dementia Studies, University of Bradford, UK
| | - Janet Carter
- Assistant Professor, Division of Psychiatry, University College London, UK
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31
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Leuzy A, Savitcheva I, Chiotis K, Lilja J, Andersen P, Bogdanovic N, Jelic V, Nordberg A. Clinical impact of [ 18F]flutemetamol PET among memory clinic patients with an unclear diagnosis. Eur J Nucl Med Mol Imaging 2019; 46:1276-1286. [PMID: 30915522 PMCID: PMC6486908 DOI: 10.1007/s00259-019-04297-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 02/25/2019] [Indexed: 12/11/2022]
Abstract
Purpose To investigate the impact of amyloid PET with [18F]flutemetamol on diagnosis and treatment management in a cohort of patients attending a tertiary memory clinic in whom, despite extensive cognitive assessment including neuropsychological testing, structural imaging, CSF biomarker analysis and in some cases [18F]FDG PET, the diagnosis remained unclear. Methods The study population consisted of 207 patients with a clinical diagnosis prior to [18F]flutemetamol PET including mild cognitive impairment (MCI; n = 131), Alzheimer’s disease (AD; n = 41), non-AD (n = 10), dementia not otherwise specified (dementia NOS; n = 20) and subjective cognitive decline (SCD; n = 5). Results Amyloid positivity was found in 53% of MCI, 68% of AD, 20% of non-AD, 20% of dementia NOS, and 60% of SCD patients. [18F]Flutemetamol PET led, overall, to a change in diagnosis in 92 of the 207 patients (44%). A high percentage of patients with a change in diagnosis was observed in the MCI group (n = 67, 51%) and in the dementia NOS group (n = 11; 55%), followed by the non-AD and AD (30% and 20%, respectively). A significant increase in cholinesterase inhibitor treatment was observed after [18F]flutemetamol PET (+218%, 34 patients before and 108 patients after). Conclusion The present study lends support to the clinical value of amyloid PET in patients with an uncertain diagnosis in the tertiary memory clinic setting.
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Affiliation(s)
- Antoine Leuzy
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics Center for Alzheimer Research, Karolinska Institutet, Neo, 7th floor, 141 83, Huddinge, Sweden
| | - Irina Savitcheva
- Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Konstantinos Chiotis
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics Center for Alzheimer Research, Karolinska Institutet, Neo, 7th floor, 141 83, Huddinge, Sweden
| | - Johan Lilja
- Department of Surgical Sciences, Radiology, Nuclear Medicine and PET, Uppsala University, Uppsala, Sweden.,Hermes Medical Solutions, Stockholm, Sweden
| | - Pia Andersen
- Clinic for Cognitive Disorders, Theme Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Nenad Bogdanovic
- Clinic for Cognitive Disorders, Theme Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Vesna Jelic
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics Center for Alzheimer Research, Karolinska Institutet, Neo, 7th floor, 141 83, Huddinge, Sweden.,Clinic for Cognitive Disorders, Theme Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Agneta Nordberg
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics Center for Alzheimer Research, Karolinska Institutet, Neo, 7th floor, 141 83, Huddinge, Sweden. .,Clinic for Cognitive Disorders, Theme Aging, Karolinska University Hospital, Stockholm, Sweden.
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32
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Verde F, Steinacker P, Weishaupt JH, Kassubek J, Oeckl P, Halbgebauer S, Tumani H, von Arnim CAF, Dorst J, Feneberg E, Mayer B, Müller HP, Gorges M, Rosenbohm A, Volk AE, Silani V, Ludolph AC, Otto M. Neurofilament light chain in serum for the diagnosis of amyotrophic lateral sclerosis. J Neurol Neurosurg Psychiatry 2019; 90:157-164. [PMID: 30309882 DOI: 10.1136/jnnp-2018-318704] [Citation(s) in RCA: 156] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/03/2018] [Accepted: 07/24/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine the diagnostic and prognostic performance of serum neurofilament light chain (NFL) in amyotrophic lateral sclerosis (ALS). METHODS This single-centre, prospective, longitudinal study included the following patients: 124 patients with ALS; 50 patients without neurodegenerative diseases; 44 patients with conditions included in the differential diagnosis of ALS (disease controls); 65 patients with other neurodegenerative diseases (20 with frontotemporal dementia, 20 with Alzheimer's disease, 19 with Parkinson's disease, 6 with Creutzfeldt-Jakob disease (CJD)). Serum NFL levels were measured using the ultrasensitive single molecule array (Simoa) technology. RESULTS Serum NFL levels were higher in ALS in comparison to all other categories except for CJD. A cut-off level of 62 pg/mL discriminated between ALS and all other conditions with 85.5% sensitivity (95% CI 78% to 91.2%) and 81.8% specificity (95% CI 74.9% to 87.4%). Among patients with ALS, serum NFL correlated positively with disease progression rate (rs=0.336, 95% CI 0.14 to 0.506, p=0.0008), and higher levels were associated with shorter survival (p=0.0054). Serum NFL did not differ among patients in different ALS pathological stages as evaluated by diffusion-tensor imaging, and in single patients NFL levels were stable over time. CONCLUSIONS Serum NFL is increased in ALS in comparison to other conditions and can serve as diagnostic and prognostic biomarker. We established a cut-off level for the diagnosis of ALS.
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Affiliation(s)
- Federico Verde
- Department of Neurology, University of Ulm, Ulm, Germany.,Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, and Department of Pathophysiology and Transplantation, 'Dino Ferrari' Center, Università degli Studi di Milano, Milan, Italy
| | | | | | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Patrick Oeckl
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | | | | | - Johannes Dorst
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Emily Feneberg
- Department of Neurology, University of Ulm, Ulm, Germany.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Benjamin Mayer
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | | | - Martin Gorges
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | - Alexander E Volk
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, and Department of Pathophysiology and Transplantation, 'Dino Ferrari' Center, Università degli Studi di Milano, Milan, Italy
| | | | - Markus Otto
- Department of Neurology, University of Ulm, Ulm, Germany
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Ahmed MR, Zhang Y, Feng Z, Lo B, Inan OT, Liao H. Neuroimaging and Machine Learning for Dementia Diagnosis: Recent Advancements and Future Prospects. IEEE Rev Biomed Eng 2018; 12:19-33. [PMID: 30561351 DOI: 10.1109/rbme.2018.2886237] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Dementia, a chronic and progressive cognitive declination of brain function caused by disease or impairment, is becoming more prevalent due to the aging population. A major challenge in dementia is achieving accurate and timely diagnosis. In recent years, neuroimaging with computer-aided algorithms have made remarkable advances in addressing this challenge. The success of these approaches is mostly attributed to the application of machine learning techniques for neuroimaging. In this review paper, we present a comprehensive survey of automated diagnostic approaches for dementia using medical image analysis and machine learning algorithms published in the recent years. Based on the rigorous review of the existing works, we have found that, while most of the studies focused on Alzheimer's disease, recent research has demonstrated reasonable performance in the identification of other types of dementia remains a major challenge. Multimodal imaging analysis deep learning approaches have shown promising results in the diagnosis of these other types of dementia. The main contributions of this review paper are as follows. 1) Based on the detailed analysis of the existing literature, this paper discusses neuroimaging procedures for dementia diagnosis. 2) It systematically explains the most recent machine learning techniques and, in particular, deep learning approaches for early detection of dementia.
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Frisoni GB, Barkhof F, Altomare D, Berkhof J, Boccardi M, Canzoneri E, Collij L, Drzezga A, Farrar G, Garibotto V, Gismondi R, Gispert JD, Jessen F, Kivipelto M, Lopes Alves I, Molinuevo JL, Nordberg A, Payoux P, Ritchie C, Savicheva I, Scheltens P, Schmidt ME, Schott JM, Stephens A, van Berckel B, Vellas B, Walker Z, Raffa N. AMYPAD Diagnostic and Patient Management Study: Rationale and design. Alzheimers Dement 2018; 15:388-399. [PMID: 30339801 DOI: 10.1016/j.jalz.2018.09.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 08/27/2018] [Accepted: 09/06/2018] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Reimbursement of amyloid-positron emission tomography (PET) is lagging due to the lack of definitive evidence on its clinical utility and cost-effectiveness. The Amyloid Imaging to Prevent Alzheimer's Disease-Diagnostic and Patient Management Study (AMYPAD-DPMS) is designed to fill this gap. METHODS AMYPAD-DPMS is a phase 4, multicenter, prospective, randomized controlled study. Nine hundred patients with subjective cognitive decline plus, mild cognitive impairment, and dementia possibly due to Alzheimer's disease will be randomized to ARM1, amyloid-PET performed early in the diagnostic workup; ARM2, amyloid-PET performed after 8 months; and ARM3, amyloid-PET performed whenever the physician chooses to do so. ENDPOINTS The primary endpoint is the difference between ARM1 and ARM2 in the proportion of patients receiving a very-high-confidence etiologic diagnosis after 3 months. Secondary endpoints address diagnosis and diagnostic confidence, diagnostic/therapeutic management, health economics and patient-related outcomes, and methods for image quantitation. EXPECTED IMPACTS AMYPAD-DPMS will supply physicians and health care payers with real-world data to plan management decisions.
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Affiliation(s)
- Giovanni B Frisoni
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland; Memory Clinic, University Hospital of Geneva, Geneva, Switzerland; Laboratory of Alzheimer's Neuroimaging and Epidemiology (LANE), Saint John of God Clinical Research Centre, Brescia, Italy.
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands; Institutes of Neurology and Healthcare Engineering, UCL, London, United Kingdom
| | - Daniele Altomare
- Laboratory of Alzheimer's Neuroimaging and Epidemiology (LANE), Saint John of God Clinical Research Centre, Brescia, Italy; Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Johannes Berkhof
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - Marina Boccardi
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland; Laboratory of Alzheimer's Neuroimaging and Epidemiology (LANE), Saint John of God Clinical Research Centre, Brescia, Italy
| | - Elisa Canzoneri
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
| | - Lyduine Collij
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | - Alexander Drzezga
- Department of Nuclear Medicine, University Hospital of Cologne, University of Cologne and German Center for Neurodegenerative Diseases (DZNE), Germany
| | - Gill Farrar
- Life Sciences, GE Healthcare, Amersham, Buckinghamshire, United Kingdom
| | - Valentina Garibotto
- Division of Nuclear Medicine and Molecular Imaging, Department of Medical Imaging, University Hospitals of Geneva, Geneva, Switzerland; NIMTlab, Faculty of Medicine, Geneva University, Geneva, Switzerland
| | | | - Juan-Domingo Gispert
- Barcelonaβeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Frank Jessen
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany; German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Miia Kivipelto
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden; Aging Theme, Karolinska University Hospital Stockholm, Sweden; University of Eastern Finland, Finland; School of Public Health, Imperial College, London, United Kingdom
| | - Isadora Lopes Alves
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | - José Luis Molinuevo
- Barcelonaβeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain
| | - Agneta Nordberg
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden; Aging Theme, Karolinska University Hospital Stockholm, Sweden
| | - Pierre Payoux
- Nuclear Medicine Department, University Hospital of Toulouse (CHU-Toulouse), Toulouse, France; ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Craig Ritchie
- Centre for Clinical Brain Sciences, Department of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
| | - Irina Savicheva
- Nuclear Medicine IRA, Medical Radiation Physics and Nuclear Medicine Imaging, Karolinska University Hospital, Sweden
| | - Philip Scheltens
- Alzheimer Center and Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | - Mark E Schmidt
- Experimental Medicine, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Jonathan M Schott
- Institute of Neurology, University College London, London, United Kingdom
| | - Andrew Stephens
- Piramal Imaging, Clinical Research and Development, Berlin, Germany
| | - Bart van Berckel
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | - Bruno Vellas
- Gerontopole of Toulouse, University Hospital of Toulouse (CHU-Toulouse), Toulouse, France; UMR INSERM 1027, University of Toulouse III, Toulouse, France
| | - Zuzana Walker
- Division of Psychiatry, University College London, London, United Kingdom; Essex Partnership University NHS Foundation Trust, United Kingdom
| | - Nicola Raffa
- Piramal Imaging, Market Access and HEOR, Berlin, Germany
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Amyloid imaging for differential diagnosis of dementia: incremental value compared to clinical diagnosis and [ 18F]FDG PET. Eur J Nucl Med Mol Imaging 2018; 46:312-323. [PMID: 30094462 PMCID: PMC6333717 DOI: 10.1007/s00259-018-4111-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 07/10/2018] [Indexed: 11/24/2022]
Abstract
Purpose Cerebral beta-amyloid and regional glucose metabolism assessed by positron emission tomography (PET) are used as diagnostic biomarkers for Alzheimer’s disease (AD). The present study validates the incremental diagnostic value of amyloid PET in addition to clinical diagnosis and [18F]FDG PET in a real-life memory clinic population. Methods Of 138 consecutive patients with cognitive impairment who received combined [18F]FDG and [11C]PIB PET, 84 were diagnosed with major neurocognitive disorder (DSM-5) and included. Baseline clinical and [18F]FDG PET diagnoses were independently established with and without access to amyloid PET results and were dichotomized into AD or non-AD disorders. The incremental value of amyloid PET was evaluated in terms of: (1) the change in clinical and [18F]FDG PET diagnoses, (2) the change in agreement between clinical and [18F]FDG PET diagnoses, and (3) diagnostic accuracy using an interdisciplinary consensus diagnosis after an extended follow-up (2.4 ± 1.3 years after PET) as the reference. Results After disclosure of the amyloid PET results, clinical and [18F]FDG PET diagnoses changed in 23% and 18% of patients, respectively, and agreement between both ratings increased from 62% to 86% (p < 0.001). The accuracy of clinical and [18F]FDG PET diagnoses improved from 71% to 89% (p < 0.01) and from 76% to 94% (p < 0.001), respectively. The additional value of amyloid PET was rather uniform in relation to age at onset and consistency with appropriate use criteria. Conclusion Amyloid PET provides significant incremental diagnostic value beyond clinical and [18F]FDG PET diagnoses of AD. Given the high diagnostic accuracy of combined clinical and amyloid PET assessment, further studies are needed to clarify the role of an additional [18F]FDG PET scan in these patients.
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Lilja J, Leuzy A, Chiotis K, Savitcheva I, Sörensen J, Nordberg A. Spatial Normalization of 18F-Flutemetamol PET Images Using an Adaptive Principal-Component Template. J Nucl Med 2018; 60:285-291. [PMID: 29903930 PMCID: PMC8833851 DOI: 10.2967/jnumed.118.207811] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 06/07/2018] [Indexed: 11/29/2022] Open
Abstract
Though currently approved for visual assessment only, there is evidence to suggest that quantification of amyloid-β (Aβ) PET images may reduce interreader variability and aid in the monitoring of treatment effects in clinical trials. Quantification typically involves a regional atlas in standard space, requiring PET images to be spatially normalized. Different uptake patterns in Aβ-positive and Aβ-negative subjects, however, make spatial normalization challenging. In this study, we proposed a method to spatially normalize 18F-flutemetamol images using a synthetic template based on principal-component images to overcome these challenges. Methods:18F-flutemetamol PET and corresponding MR images from a phase II trial (n = 70), including subjects ranging from Aβ-negative to Aβ-positive, were spatially normalized to standard space using an MR-driven registration method (SPM12). 18F-flutemetamol images were then intensity-normalized using the pons as a reference region. Principal-component images were calculated from the intensity-normalized images. A linear combination of the first 2 principal-component images was then used to model a synthetic template spanning the whole range from Aβ-negative to Aβ-positive. The synthetic template was then incorporated into our registration method, by which the optimal template was calculated as part of the registration process, providing a PET-only–driven registration method. Evaluation of the method was done in 2 steps. First, coregistered gray matter masks generated using SPM12 were spatially normalized using the PET- and MR-driven methods, respectively. The spatially normalized gray matter masks were then visually inspected and quantified. Second, to quantitatively compare the 2 registration methods, additional data from an ongoing study were spatially normalized using both methods, with correlation analysis done on the resulting cortical SUV ratios. Results: All scans were successfully spatially normalized using the proposed method with no manual adjustments performed. Both visual and quantitative comparison between the PET- and MR-driven methods showed high agreement in cortical regions. 18F-flutemetamol quantification showed strong agreement between the SUV ratios for the PET- and MR-driven methods (R2 = 0.996; pons reference region). Conclusion: The principal-component template registration method allows for robust and accurate registration of 18F-flutemetamol images to a standardized template space, without the need for an MR image.
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Segovia F, Sánchez-Vañó R, Górriz JM, Ramírez J, Sopena-Novales P, Testart Dardel N, Rodríguez-Fernández A, Gómez-Río M. Using CT Data to Improve the Quantitative Analysis of 18F-FBB PET Neuroimages. Front Aging Neurosci 2018; 10:158. [PMID: 29930505 PMCID: PMC6001114 DOI: 10.3389/fnagi.2018.00158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 05/08/2018] [Indexed: 01/17/2023] Open
Abstract
18F-FBB PET is a neuroimaging modality that is been increasingly used to assess brain amyloid deposits in potential patients with Alzheimer's disease (AD). In this work, we analyze the usefulness of these data to distinguish between AD and non-AD patients. A dataset with 18F-FBB PET brain images from 94 subjects diagnosed with AD and other disorders was evaluated by means of multiple analyses based on t-test, ANOVA, Fisher Discriminant Analysis and Support Vector Machine (SVM) classification. In addition, we propose to calculate amyloid standardized uptake values (SUVs) using only gray-matter voxels, which can be estimated using Computed Tomography (CT) images. This approach allows assessing potential brain amyloid deposits along with the gray matter loss and takes advantage of the structural information provided by most of the scanners used for PET examination, which allow simultaneous PET and CT data acquisition. The results obtained in this work suggest that SUVs calculated according to the proposed method allow AD and non-AD subjects to be more accurately differentiated than using SUVs calculated with standard approaches.
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Affiliation(s)
- Fermín Segovia
- Department of Signal Theory, Networking and Communications, University of Granada, Granada, Spain
| | - Raquel Sánchez-Vañó
- Department of Nuclear Medicine, "9 de Octubre" Hospital, Valencia, Spain.,Clinical Medicine and Public Health Doctoral Program of the University of Granada, Granada, Spain
| | - Juan M Górriz
- Department of Signal Theory, Networking and Communications, University of Granada, Granada, Spain.,Biosanitary Investigation Institute of Granada, Granada, Spain
| | - Javier Ramírez
- Department of Signal Theory, Networking and Communications, University of Granada, Granada, Spain.,Biosanitary Investigation Institute of Granada, Granada, Spain
| | | | - Nathalie Testart Dardel
- Department of Nuclear Medicine, "Virgen de las Nieves" University Hospital, Granada, Spain.,Department of Nuclear Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Antonio Rodríguez-Fernández
- Biosanitary Investigation Institute of Granada, Granada, Spain.,Department of Nuclear Medicine, "Virgen de las Nieves" University Hospital, Granada, Spain
| | - Manuel Gómez-Río
- Biosanitary Investigation Institute of Granada, Granada, Spain.,Department of Nuclear Medicine, "Virgen de las Nieves" University Hospital, Granada, Spain
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Fantoni ER, Chalkidou A, O’ Brien JT, Farrar G, Hammers A. A Systematic Review and Aggregated Analysis on the Impact of Amyloid PET Brain Imaging on the Diagnosis, Diagnostic Confidence, and Management of Patients being Evaluated for Alzheimer's Disease. J Alzheimers Dis 2018; 63:783-796. [PMID: 29689725 PMCID: PMC5929301 DOI: 10.3233/jad-171093] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Amyloid PET (aPET) imaging could improve patient outcomes in clinical practice, but the extent of impact needs quantification. OBJECTIVE To provide an aggregated quantitative analysis of the value added by aPET in cognitively impaired subjects. METHODS Systematic literature searches were performed in Embase and Medline until January 2017. 1,531 cases over 12 studies were included (1,142 cases over seven studies in the primary analysis where aPET was the key biomarker; the remaining cases included as defined groups in the secondary analysis). Data was abstracted by consensus among two observers and assessed for bias. Clinical utility was measured by diagnostic change, diagnostic confidence, and patient management before and after aPET. Three groups were further analyzed: control patients for whom feedback of aPET scan results was delayed; aPET Appropriate Use Criteria (AUC+) cases; and patients undergoing additional FDG/CSF testing. RESULTS For 1,142 cases with only aPET, 31.3% of diagnoses were revised, whereas 3.2% of diagnoses changed in the delayed aPET control group (p < 0.0001). Increased diagnostic confidence following aPET was found for 62.1% of 870 patients. Management changes with aPET were found in 72.2% of 740 cases and in 55.5% of 299 cases in the control group (p < 0.0001). The diagnostic value of aPET in AUC+ patients or when FDG/CSF were additionally available did not substantially differ from the value of aPET alone in the wider population. CONCLUSIONS Amyloid PET contributed to diagnostic revision in almost a third of cases and demonstrated value in increasing diagnostic confidence and refining management plans.
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Affiliation(s)
| | - Anastasia Chalkidou
- King’s Technology Evaluation Centre (KiTEC), London, UK
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK; King’s College London and Guy’s and St Thomas’ PET Centre, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, UK
| | | | | | - Alexander Hammers
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK; King’s College London and Guy’s and St Thomas’ PET Centre, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, UK
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