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Olğun Y, Aksoy Poyraz C, Bozluolçay M, Poyraz BÇ. Quantitative EEG in the Differential Diagnosis of Dementia Subtypes. J Geriatr Psychiatry Neurol 2024; 37:368-378. [PMID: 38217438 DOI: 10.1177/08919887241227410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2024]
Abstract
OBJECTIVE Most neurodegenerative dementias present with substantial overlap in clinical features. Therefore, differential diagnosis is often a challenging task necessitating costly and sometimes invasive diagnostic procedures. A promising, non-invasive and cost-effective method is the widely available electroencephalography (EEG). METHODS Twenty-three subjects with Alzheimer's disease (AD), 28 subjects with dementia with Lewy bodies (DLB), 15 subjects with frontotemporal dementias (FTDs), and 22 healthy controls (HC) were enrolled. Nineteen channel computerized EEG recordings were acquired. Mean relative powers were calculated using the standard frequency bands. Theta/alpha ratio (TAR), theta/beta ratio (TBR), a spectral index of (alpha + beta)/(theta + delta) and an alpha reactivity index (alpha in eyes-open condition/alpha in eyes-closed condition) were also calculated. Receiver operating characteristic (ROC) analyses were performed to assess diagnostic accuracy. RESULTS For the comparison of EEG measures across groups, we performed a multivariate ANOVA followed by univariate ANOVAs controlling for the effects of age, with post hoc tests. Theta power and TBR were increased in DLB compared to other groups. Alpha power was decreased in DLB compared to HC and FTD; and in AD compared to FTD. Beta power was decreased in DLB compared to AD and HC. Furthermore, regional analyses demonstrated a unique pattern of theta power increase in DLB; affecting frontal, central, parietal, occipital, and temporal regions. In AD, theta power increased compared to HC in parietal, occipital, and right temporal regions. TAR was increased in DLB compared to other groups; and in AD compared to HC. Finally, alpha reactivity index was higher in DLB compared to HC and FTD. In AD, EEG slowing was associated with cognitive impairment, while in DLB, this was associated with higher DLB characteristics. In the ROC analyses to distinguish DLB from FTD and AD, measures of EEG slowing yielded high area under curve values, with good specificities. Also, decreased alpha reactivity could distinguish DLB from FTD with good specificity. EEG slowing in DLB showed a diffuse pattern compared to AD, where a posterior and temporal slowing predominated. CONCLUSION We showed that EEG slowing was satisfactory in distinguishing DLB patients from AD and FTD patients. Notably, this slowing was a characteristic finding in DLB patients, even at early stages, while it paralleled disease progression in AD. Furthermore, EEG slowing in DLB showed a diffuse pattern compared to AD, where a posterior and temporal slowing predominated. These findings align with the previous evidence of the diencephalic dysfunction in DLB.
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Affiliation(s)
- Yeşim Olğun
- Department of Psychiatry, Cerrahpaşa Medical School, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Cana Aksoy Poyraz
- Department of Psychiatry, Cerrahpaşa Medical School, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Melda Bozluolçay
- Department of Neurology, Cerrahpaşa Medical School, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Burç Çağrı Poyraz
- Department of Psychiatry, Cerrahpaşa Medical School, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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Athanasio BS, Oliveira ACDS, Pedrosa AL, Borges RS, Neto AOM, Oliveira RA, de Resende EDPF, de Moraes RF, Caramelli P, de Souza LC. The role of brain perfusion SPECT in the diagnosis of frontotemporal dementia: A systematic review. J Neuroimaging 2024; 34:308-319. [PMID: 38192155 DOI: 10.1111/jon.13189] [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: 08/01/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND AND PURPOSE Frontotemporal dementia (FTD) is the second most common cause of presenile dementia. The clinical distinction between FTD, Alzheimer's disease (AD), and other dementias is a clinical challenge. Brain perfusion SPECT may contribute to the diagnosis of FTD, but its value is unclear. METHODS We performed a systematic review to investigate the diagnostic accuracy of the brain SPECT in (1) distinguishing FTD from AD and other dementias and (2) differentiating FTD variants. RESULTS Overall, 391 studies were retrieved on the initial search and 35 studies composed the final selection, comprising a total number of 3142 participants of which 1029 had FTD. The sensitivity and the specificity for the differential diagnosis of FTD versus AD ranged from 56% to 88% and from 51% to 93%, respectively. SPECT is not superior to the clinical method of diagnosis, but the combination of SPECT with clinical data seems to improve the diagnostic accuracy. CONCLUSION Brain perfusion SPECT has a limited value in the diagnostic framework of FTD. SPECT can be performed when FDG-PET is not available. SPECT is recommended only for selected cases when the diagnosis is challenging using conventional methods.
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Affiliation(s)
- Bruno S Athanasio
- Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | | | - Ana Luísa Pedrosa
- Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Rafael S Borges
- Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Avelar O M Neto
- Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Rafael A Oliveira
- Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Elisa de Paula França de Resende
- Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
- Grupo de Neurologia Cognitiva e do Comportamento, Faculdade de Medicina da UFMG, Belo Horizonte, Brazil
| | - Renata Freire de Moraes
- Instituto Hermes Pardini, Belo Horizonte, Brazil
- Programa de Pós-Graduação em Neurociências, UFMG, Belo Horizonte, Brazil
| | - Paulo Caramelli
- Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
- Grupo de Neurologia Cognitiva e do Comportamento, Faculdade de Medicina da UFMG, Belo Horizonte, Brazil
- Programa de Pós-Graduação em Neurociências, UFMG, Belo Horizonte, Brazil
| | - Leonardo Cruz de Souza
- Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
- Grupo de Neurologia Cognitiva e do Comportamento, Faculdade de Medicina da UFMG, Belo Horizonte, Brazil
- Programa de Pós-Graduação em Neurociências, UFMG, Belo Horizonte, Brazil
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Malotaux V, Colmant L, Quenon L, Huyghe L, Gérard T, Dricot L, Ivanoiu A, Lhommel R, Hanseeuw B. Suspecting Non-Alzheimer's Pathologies and Mixed Pathologies: A Comparative Study Between Brain Metabolism and Tau Images. J Alzheimers Dis 2024; 97:421-433. [PMID: 38108350 PMCID: PMC10789317 DOI: 10.3233/jad-230696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) pathology can be disclosed in vivo using amyloid and tau imaging, unlike non-AD neuropathologies for which no specific markers exist. OBJECTIVE We aimed to compare brain hypometabolism and tauopathy to unveil non-AD pathologies. METHODS Sixty-one patients presenting cognitive complaints (age 48-90), including 32 with positive AD biomarkers (52%), performed [18F]-Fluorodeoxyglucose (FDG)-PET (brain metabolism) and [18F]-MK-6240-PET (tau). We normalized these images using data from clinically normal individuals (n = 30), resulting in comparable FDG and tau z-scores. We computed between-patients correlations to evaluate regional associations. For each patient, a predominant biomarker (i.e., Hypometabolism > Tauopathy or Hypometabolism≤Tauopathy) was determined in the temporal and frontoparietal lobes. We computed within-patient correlations between tau and metabolism and investigated their associations with demographics, cognition, cardiovascular risk factors (CVRF), CSF biomarkers, and white matter hypointensities (WMH). RESULTS We observed negative associations between tau and FDG in 37 of the 68 cortical regions-of-interest (average Pearson's r = -0.25), mainly in the temporal lobe. Thirteen patients (21%) had Hypometabolism > Tauopathy whereas twenty-five patients (41%) had Hypometabolism≤Tauopathy. Tau-predominant patients were more frequently females and had greater amyloid burden. Twenty-three patients (38%) had Hypometabolism≤Tauopathy in the temporal lobe, but Hypometabolism > Tauopathy in the frontoparietal lobe. This group was older and had higher CVRF than Tau-predominant patients. Patients with more negative associations between tau and metabolism were younger, had worse cognition, and greater amyloid and WMH burdens. CONCLUSIONS Tau-FDG comparison can help suspect non-AD pathologies in patients presenting cognitive complaints. Stronger Tau-FDG correlations are associated with younger age, worse cognition, and greater amyloid and WMH burdens.
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Affiliation(s)
- Vincent Malotaux
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
| | - Lise Colmant
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
- Department of Neurology, Saint-Luc University Hospital, Brussels, Belgium
| | - Lisa Quenon
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
- Department of Neurology, Saint-Luc University Hospital, Brussels, Belgium
| | - Lara Huyghe
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
| | - Thomas Gérard
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
- Department of Nuclear Medicine, Saint-Luc University Hospital, Brussels, Belgium
| | - Laurence Dricot
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
| | - Adrian Ivanoiu
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
- Department of Neurology, Saint-Luc University Hospital, Brussels, Belgium
| | - Renaud Lhommel
- Department of Nuclear Medicine, Saint-Luc University Hospital, Brussels, Belgium
| | - Bernard Hanseeuw
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
- Department of Neurology, Saint-Luc University Hospital, Brussels, Belgium
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- WEL Research Institute, Welbio department, Wavre, Belgium
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Zheng BW, Wu T, Ju JX, Wu LL, Zhang HJ, Lian YF, Tong G, Li QJ, Qiu C, Zhou HC, Zheng RQ, Ren J. Contrast-Enhanced Ultrasound for Biliary Ischemia: A Possible New Clinical Indication. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1927-1934. [PMID: 33270273 DOI: 10.1002/jum.15577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/12/2020] [Accepted: 10/27/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Biliary perfusion is considered to contribute to biliary diseases, but routine imaging methods are insufficient to show it. This research investigated the ability of contrast-enhanced ultrasound (CEUS) for biliary perfusion in a biliary ischemia model. METHODS This research consisted of 2 parts. First, to determine whether CEUS enhancement of the tiny biliary wall represents biliary perfusion, a vascular tracer was used as a reference to evaluate the consistency with the enhancement of the biliary wall on CEUS and the staining by the vascular tracer under the conditions of occluded and recovered biliary perfusion. In the second part, the ability of CEUS for biliary ischemia was further evaluated with microvascular density measurement as a reference. The enhancement patterns were assigned CEUS scores, in which higher scores meant more decreased enhancement, and the diagnostic ability of CEUS was assessed by a receiver operating characteristic curve analysis. RESULTS The biliary wall was unstained by the vascular tracer and nonenhanced on CEUS when biliary perfusion was interrupted and was stained blue and enhanced after recovery. The biliary wall in the ischemia surgery group showed lower microvascular density measurements (P < .001), decreased enhancement levels (P < .001), and higher CEUS scores (P < .001). When a CEUS score of 3 or higher (obvious decrease of the biliary wall to hypoenhancement or nonenhancement in the arterial phase or rapid wash-out to nonenhancement in the portal venous phase) was applied, CEUS had sensitivity of 87.8%, specificity of 98.3%, accuracy of 93.8%, and an area under the receiver operating characteristic curve of 0.98. CONCLUSIONS Contrast enhancement of the biliary wall on CEUS represents biliary perfusion and has reasonably good diagnostic performance for biliary ischemia in an experimental animal setting.
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Affiliation(s)
- Bo-Wen Zheng
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Guangzhou, China
| | - Tao Wu
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Guangzhou, China
| | - Jin-Xiu Ju
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Guangzhou, China
| | - Li-Li Wu
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Guangzhou, China
| | - Hong-Jun Zhang
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Guangzhou, China
| | - Yu-Fan Lian
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Guangzhou, China
| | - Ge Tong
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Guangzhou, China
| | - Qiao-Jia Li
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Guangzhou, China
| | - Chen Qiu
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Guangzhou, China
| | - Hui-Chao Zhou
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Guangzhou, China
| | - Rong-Qin Zheng
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Guangzhou, China
| | - Jie Ren
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Guangzhou, China
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Valotassiou V, Angelidis G, Psimadas D, Tsougos I, Georgoulias P. In the era of FDG PET, is it time for brain perfusion SPECT to gain a place in Alzheimer's disease imaging biomarkers? Eur J Nucl Med Mol Imaging 2020; 48:969-971. [PMID: 33078261 DOI: 10.1007/s00259-020-05077-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/12/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Varvara Valotassiou
- Department of Nuclear Medicine, University Hospital of Larissa, Thessaly, Greece.
| | - George Angelidis
- Department of Nuclear Medicine, University Hospital of Larissa, Thessaly, Greece
| | - Dimitrios Psimadas
- Department of Nuclear Medicine, University Hospital of Larissa, Thessaly, Greece
| | - Ioannis Tsougos
- Medical Physics Department, Medical School, University of Thessaly, Thessaly, Greece
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Treyer V, Gietl AF, Suliman H, Gruber E, Meyer R, Buchmann A, Johayem A, Unschuld PG, Nitsch RM, Buck A, Ametamey SM, Hock C. Reduced uptake of [11C]-ABP688, a PET tracer for metabolic glutamate receptor 5 in hippocampus and amygdala in Alzheimer's dementia. Brain Behav 2020; 10:e01632. [PMID: 32304284 PMCID: PMC7303388 DOI: 10.1002/brb3.1632] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 02/13/2020] [Accepted: 03/10/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Metabotropic glutamate receptors play a critical role in the pathogenesis of Alzheimer's disease due to their involvement in processes of memory formation, neuroplasticity, and synaptotoxity. The objective of the current study was to study mGluR5 availability measured by [11 C]-ABP688 (ABP) in patients with clinically diagnosed Alzheimer's dementia (AD). METHODS A bolus-infusion protocol of [11 C]-ABP688 was applied in 9 subjects with AD and 10 cognitively healthy controls (Controls) to derive distribution volume estimates of mGluR5. Furthermore, we also estimated cerebral perfusion by averaging early frame signal of initial ABP bolus injection. RESULTS Subjects with Alzheimer's dementia (mean age: 77.3/SD 5.7) were older than controls (mean age: 68.5/SD: 9.6) and scored lower on the MMSE (22.1/SD2.7 vs. 29.0/SD0.8). There were no overall differences in ABP signal. However, distribution volume ratio (DVR) for ABP was reduced in the bilateral hippocampus (AD: 1.34/SD: 0.40 vs. Control: 1.84/SD:0.31, p = .007) and the bilateral amygdala (AD:1.86/SD:0.26 vs. Control:2.33/SD:0.37 p = .006) in AD patients compared to controls. Estimate of cerebral blood flow was reduced in the bilateral hippocampus in AD (AD:0.75/SD:0.10 vs. Control:0.86/SD:0.09 p = .02). CONCLUSION Our findings demonstrate reduced mGluR5 binding in the hippocampus and amygdala in Alzheimer's dementia. Whether this is due to synaptic loss and/or consecutive reduction of potential binding sites or reflects disease inherent mechanisms remains to be elucidated in future studies.
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Affiliation(s)
- Valerie Treyer
- Institute for Regenerative Medicine (IREM), University of Zurich, Schlieren, Switzerland.,Department of Nuclear Medicine, University Hospital of Zurich, Zurich, Switzerland
| | - Anton F Gietl
- Institute for Regenerative Medicine (IREM), University of Zurich, Schlieren, Switzerland
| | - Husam Suliman
- Hospital for Psychogeriatric Medicine, University of Zurich, Zurich, Switzerland
| | - Esmeralda Gruber
- Institute for Regenerative Medicine (IREM), University of Zurich, Schlieren, Switzerland
| | - Rafael Meyer
- Institute for Regenerative Medicine (IREM), University of Zurich, Schlieren, Switzerland
| | - Andreas Buchmann
- Institute for Regenerative Medicine (IREM), University of Zurich, Schlieren, Switzerland
| | - Anass Johayem
- Department of Nuclear Medicine, University Hospital of Zurich, Zurich, Switzerland
| | - Paul G Unschuld
- Hospital for Psychogeriatric Medicine, University of Zurich, Zurich, Switzerland
| | - Roger M Nitsch
- Institute for Regenerative Medicine (IREM), University of Zurich, Schlieren, Switzerland.,Neurimmune, Schlieren, Switzerland
| | - Alfred Buck
- Department of Nuclear Medicine, University Hospital of Zurich, Zurich, Switzerland
| | - Simon M Ametamey
- Institute of Radiopharmaceutical Sciences, ETH Zurich, Zurich, Switzerland
| | - Christoph Hock
- Institute for Regenerative Medicine (IREM), University of Zurich, Schlieren, Switzerland.,Neurimmune, Schlieren, Switzerland
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Stereological Investigation of Regional Brain Volumes after Acute and Chronic Cuprizone-Induced Demyelination. Cells 2019; 8:cells8091024. [PMID: 31484353 PMCID: PMC6770802 DOI: 10.3390/cells8091024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/19/2019] [Accepted: 08/30/2019] [Indexed: 02/03/2023] Open
Abstract
Brain volume measurement is one of the most frequently used biomarkers to establish neuroprotective effects during pre-clinical multiple sclerosis (MS) studies. Furthermore, whole-brain atrophy estimates in MS correlate more robustly with clinical disability than traditional, lesion-based metrics. However, the underlying mechanisms leading to brain atrophy are poorly understood, partly due to the lack of appropriate animal models to study this aspect of the disease. The purpose of this study was to assess brain volumes and neuro-axonal degeneration after acute and chronic cuprizone-induced demyelination. C57BL/6 male mice were intoxicated with cuprizone for up to 12 weeks. Brain volume, as well as total numbers and densities of neurons, were determined using design-based stereology. After five weeks of cuprizone intoxication, despite severe demyelination, brain volumes were not altered at this time point. After 12 weeks of cuprizone intoxication, a significant volume reduction was found in the corpus callosum and diverse subcortical areas, particularly the internal capsule and the thalamus. Thalamic volume loss was accompanied by glucose hypermetabolism, analyzed by [18F]-fluoro-2-deoxy-d-glucose (18F-FDG) positron-emission tomography. This study demonstrates region-specific brain atrophy of different subcortical brain regions after chronic cuprizone-induced demyelination. The chronic cuprizone demyelination model in male mice is, thus, a useful tool to study the underlying mechanisms of subcortical brain atrophy and to investigate the effectiveness of therapeutic interventions.
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Van Patten R, Greif T, Britton K, Tremont G. Single-photon emission computed tomography (SPECT) perfusion and neuropsychological performance in mild cognitive impairment. J Clin Exp Neuropsychol 2019; 41:530-543. [PMID: 30880594 DOI: 10.1080/13803395.2019.1586838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Single-photon emission computed tomography (SPECT) is an affordable neuroimaging technique that measures cerebral perfusion and has been utilized repeatedly in aging populations. However, we are aware of no studies to date examining relationships between SPECT imaging and comprehensive neuropsychological evaluations in a clinical sample of patients with mild cognitive impairment (MCI). Participants were 124 older adults with MCI (age, M = 75.07 years, SD = 7.65; years of education, M = 14.03, SD = 3.09; 60.2% female) who underwent neuropsychological evaluations and brain SPECT scans as part of their routine clinical care. Based on SPECT interpretations, participants were grouped by suspected etiology (i.e., the neuroradiologists noted that hypoperfusion patterns were most consistent with Alzheimer's disease, AD; frontotemporal lobar degeneration, FTLD; or other disease processes) and regional hypoperfusion (e.g., frontal, temporal, right/left hemisphere). Neuropsychological tests were grouped into domain scores (i.e., attention/processing speed, language, visuospatial, memory, executive; verbal/nonverbal). Consistent with a priori predictions, patients with an AD pattern of hypoperfusion scored lower than comparison groups on the attention/processing speed (partial χ2 = 0.10) and memory (partial χ2 = 0.07) composites. More patients with the AD-hypoperfusion signal met criteria for amnestic MCI (82%) than did those with a non-AD pattern (70%); this result approached statistical significance (p = .07). Contrary to hypotheses, patients whose SPECT scans were most consistent with FTLD did not underperform on the executive composite, and most regional analyses were nonsignificant. When integrating SPECT data into their clinical conceptualizations of MCI, neuropsychologists should place more weight on AD patterns of hypoperfusion, while de-emphasizing data suggestive of FTLD or regional pathology. Alternative neurodiagnostic markers may be more informative in these instances.
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Affiliation(s)
- Ryan Van Patten
- a Department of Psychiatry and Human Behavior, Warren Alpert Medical School , Brown University , Providence , RI , USA.,b Department of Psychiatry , Unviersity of California-San Diego , San Diego , CA , USA
| | - Taylor Greif
- c Department of Psychology , Saint Louis University , St. Louis , MO , USA
| | - Karysa Britton
- d Neuropsychology Program , Rhode Island Hospital , Providence , RI , USA
| | - Geoffrey Tremont
- a Department of Psychiatry and Human Behavior, Warren Alpert Medical School , Brown University , Providence , RI , USA.,d Neuropsychology Program , Rhode Island Hospital , Providence , RI , USA
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Baumgartner A, Frings L, Schiller F, Stich O, Mix M, Egger K, Schluh G, Rauer S, Meyer PT. Regional neuronal activity in patients with relapsing remitting multiple sclerosis. Acta Neurol Scand 2018; 138:466-474. [PMID: 30091258 DOI: 10.1111/ane.13012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 07/31/2018] [Accepted: 08/01/2018] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Although interferon-beta is an established drug for relapsing remitting multiple sclerosis (RRMS), its impact on neuronal activity is not well understood. METHODS We investigated 15 patients with RRMS by [18 F]fluorodeoxyglucose positron emission tomography (FDG-PET) to assess cerebral metabolic rate of glucose (CMRglc ) before interferon-beta therapy. Further, we performed clinical and neuropsychological investigations. In nine patients, these investigations were repeated after 6 months of therapy. Ten healthy controls were also studied. RESULTS We found no significant differences in absolute CMRglc between patients and controls, or in patients before and during treatment. However, during treatment, relative regional glucose metabolism (rCMRlglc ) was decreased in cerebellum and increased in parts of left inferior parietal, temporo-occipital, frontal cortical areas, left striatum and right insula. In untreated patients, higher fatigue was associated with lower rCMRlglc in portions of left posterior cingulate cortex, and higher depression was associated with lower rCMRlglc within the left superior temporal sulcus. In the pooled sample, higher depression was associated with higher rCMRlglc in parts of the right precuneus. CONCLUSIONS Our results indicate effects of IFN-beta treatment on cerebellar, cortical and subcortical neuronal function. Moreover, more severe fatigue and depression in untreated patients seem to be associated with reduced neuronal activity in left posterior cingulate cortex and left superior temporal cortex, respectively.
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Affiliation(s)
- Annette Baumgartner
- Department of Neurology; Medical Center - University of Freiburg; Faculty of Medicine; University of Freiburg; Freiburg Germany
- Department of Psychiatry; Medical Center - University of Freiburg; Faculty of Medicine; University of Freiburg; Freiburg Germany
| | - Lars Frings
- Department of Nuclear Medicine; Medical Center - University of Freiburg; Faculty of Medicine; University of Freiburg; Freiburg Germany
| | - Florian Schiller
- Department of Nuclear Medicine; Medical Center - University of Freiburg; Faculty of Medicine; University of Freiburg; Freiburg Germany
| | - Oliver Stich
- Neurology; Medical Care Center; Konstanz Germany
| | - Michael Mix
- Department of Nuclear Medicine; Medical Center - University of Freiburg; Faculty of Medicine; University of Freiburg; Freiburg Germany
| | - Karl Egger
- Department of Neuroradiology; Medical Center; Faculty of Medicine; University of Freiburg; Freiburg Germany
| | - Gisa Schluh
- Department of Neurology; Medical Center - University of Freiburg; Faculty of Medicine; University of Freiburg; Freiburg Germany
| | - Sebastian Rauer
- Department of Neurology; Medical Center - University of Freiburg; Faculty of Medicine; University of Freiburg; Freiburg Germany
| | - Philipp T. Meyer
- Department of Nuclear Medicine; Medical Center - University of Freiburg; Faculty of Medicine; University of Freiburg; Freiburg Germany
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Venturelli M, Pedrinolla A, Boscolo Galazzo I, Fonte C, Smania N, Tamburin S, Muti E, Crispoltoni L, Stabile A, Pistilli A, Rende M, Pizzini FB, Schena F. Impact of Nitric Oxide Bioavailability on the Progressive Cerebral and Peripheral Circulatory Impairments During Aging and Alzheimer's Disease. Front Physiol 2018; 9:169. [PMID: 29593548 PMCID: PMC5861210 DOI: 10.3389/fphys.2018.00169] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 02/20/2018] [Indexed: 11/19/2022] Open
Abstract
Advanced aging, vascular dysfunction, and nitric oxide (NO) bioavailability are recognized risk factors for Alzheimer's disease (AD). However, the contribution of AD, per se, to this putative pathophysiological mechanism is still unclear. To better answer this point, we quantified cortical perfusion with arterial spin labeling (PVC-CBF), measured ultrasound internal carotid (ICA), and femoral (FA) artery blood flow in a group of patients with similar age (~78 years) but different cognitive impairment (i.e., mild cognitive impairment MCI, mild AD-AD1, moderate AD-AD2, and severe AD-AD3) and compared them to young and healthy old (aged-matched) controls. NO-metabolites and passive leg-movement (PLM) induced hyperemia were used to assess systemic vascular function. Ninety-eight individuals were recruited for this study. PVC-CBF, ICA, and FA blood flow were markedly (range of 9–17%) and significantly (all p < 0.05) reduced across the spectrum from YG to OLD, MCI, AD1, AD2, AD3 subjects. Similarly, plasma level of nitrates and the values of PLM were significantly reduced (range of 8–26%; p < 0.05) among the six groups. Significant correlations were retrieved between plasma nitrates, PLM and PVC-CBF, CA, and FA blood flow. This integrative and comprehensive approach to vascular changes in aging and AD showed progressive changes in NO bioavailability and cortical, extracranial, and peripheral circulation in patients with AD and suggested that they are directly associated with AD and not to aging. Moreover, these results suggest that AD-related impairments of circulation are progressive and not confined to the brain. The link between cardiovascular and the central nervous systems degenerative processes in patients at different severity of AD is likely related to the depletion of NO.
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Affiliation(s)
- Massimo Venturelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | | | - Cristina Fonte
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Neuromotor and Cognitive Rehabilitation Research Centre, University of Verona, Verona, Italy
| | - Nicola Smania
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Neuromotor and Cognitive Rehabilitation Research Centre, University of Verona, Verona, Italy
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Lucia Crispoltoni
- Department of Surgical and Biomedical Sciences, Section of Human Anatomy, School of Medicine, University of Perugia, Perugia, Italy
| | - Annamaria Stabile
- Department of Surgical and Biomedical Sciences, Section of Human Anatomy, School of Medicine, University of Perugia, Perugia, Italy
| | - Alessandra Pistilli
- Department of Surgical and Biomedical Sciences, Section of Human Anatomy, School of Medicine, University of Perugia, Perugia, Italy
| | - Mario Rende
- Department of Surgical and Biomedical Sciences, Section of Human Anatomy, School of Medicine, University of Perugia, Perugia, Italy
| | - Francesca B Pizzini
- Neuroradiology, Department of Diagnostics and Pathology, Verona University Hospital, Verona, Italy
| | - Federico Schena
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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11
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Kleinberger G, Brendel M, Mracsko E, Wefers B, Groeneweg L, Xiang X, Focke C, Deußing M, Suárez-Calvet M, Mazaheri F, Parhizkar S, Pettkus N, Wurst W, Feederle R, Bartenstein P, Mueggler T, Arzberger T, Knuesel I, Rominger A, Haass C. The FTD-like syndrome causing TREM2 T66M mutation impairs microglia function, brain perfusion, and glucose metabolism. EMBO J 2017; 36:1837-1853. [PMID: 28559417 DOI: 10.15252/embj.201796516] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 04/21/2017] [Accepted: 04/27/2017] [Indexed: 12/31/2022] Open
Abstract
Genetic variants in the triggering receptor expressed on myeloid cells 2 (TREM2) increase the risk for several neurodegenerative diseases including Alzheimer's disease and frontotemporal dementia (FTD). Homozygous TREM2 missense mutations, such as p.T66M, lead to the FTD-like syndrome, but how they cause pathology is unknown. Using CRISPR/Cas9 genome editing, we generated a knock-in mouse model for the disease-associated Trem2 p.T66M mutation. Consistent with a loss-of-function mutation, we observe an intracellular accumulation of immature mutant Trem2 and reduced generation of soluble Trem2 similar to patients with the homozygous p.T66M mutation. Trem2 p.T66M knock-in mice show delayed resolution of inflammation upon in vivo lipopolysaccharide stimulation and cultured macrophages display significantly reduced phagocytic activity. Immunohistochemistry together with in vivo TSPO small animal positron emission tomography (μPET) demonstrates an age-dependent reduction in microglial activity. Surprisingly, perfusion magnetic resonance imaging and FDG-μPET imaging reveal a significant reduction in cerebral blood flow and brain glucose metabolism. Thus, we demonstrate that a TREM2 loss-of-function mutation causes brain-wide metabolic alterations pointing toward a possible function of microglia in regulating brain glucose metabolism.
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Affiliation(s)
- Gernot Kleinberger
- Biomedical Center (BMC), Biochemistry, Ludwig-Maximilians-Universität München, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Matthias Brendel
- Department of Nuclear Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Eva Mracsko
- NORD Discovery & Translational Area, Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland
| | - Benedikt Wefers
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Institute of Developmental Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Linda Groeneweg
- NORD Discovery & Translational Area, Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland
| | - Xianyuan Xiang
- Biomedical Center (BMC), Biochemistry, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Carola Focke
- Department of Nuclear Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Maximilian Deußing
- Department of Nuclear Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Marc Suárez-Calvet
- Biomedical Center (BMC), Biochemistry, Ludwig-Maximilians-Universität München, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Fargol Mazaheri
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Samira Parhizkar
- Biomedical Center (BMC), Biochemistry, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Nadine Pettkus
- Biomedical Center (BMC), Biochemistry, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Wolfgang Wurst
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Institute of Developmental Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,Technische Universität München, Freising-Weihenstephan, Germany
| | - Regina Feederle
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Helmholtz Center Munich, German Research Center for Environmental Health, Institute for Diabetes and Obesity, Core Facility Monoclonal Antibody Development, Munich, Germany
| | - Peter Bartenstein
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.,Department of Nuclear Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Thomas Mueggler
- NORD Discovery & Translational Area, Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland
| | - Thomas Arzberger
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Center for Neuropathology and Prion Research, Ludwig-Maximilians-Universität München, Munich, Germany.,Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Irene Knuesel
- NORD Discovery & Translational Area, Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland
| | - Axel Rominger
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.,Department of Nuclear Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Christian Haass
- Biomedical Center (BMC), Biochemistry, Ludwig-Maximilians-Universität München, Munich, Germany .,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
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12
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Allan CL, Behrman S, Ebmeier KP, Valkanova V. Diagnosing early cognitive decline-When, how and for whom? Maturitas 2016; 96:103-108. [PMID: 28041588 DOI: 10.1016/j.maturitas.2016.11.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 11/28/2016] [Indexed: 12/19/2022]
Abstract
Mild cognitive impairment (MCI) is a term used to describe cognitive impairment in one or more cognitive domains that is greater than any expected age-related changes, but not of the magnitude to warrant a diagnosis of dementia. This review considers how early cognitive decline is diagnosed, focusing on the use of neuropsychological tests and neuroimaging, as well as the differential diagnosis. Potential treatments, including secondary prevention, post-diagnostic support and self-help are discussed. Finally, medico-legal matters such as driving, lasting power of attorney and employment are outlined.
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Affiliation(s)
- Charlotte L Allan
- Centre for the Health of the Elderly, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - Sophie Behrman
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Klaus P Ebmeier
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.
| | - Vyara Valkanova
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
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13
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Daerr S, Brendel M, Zach C, Mille E, Schilling D, Zacherl MJ, Bürger K, Danek A, Pogarell O, Schildan A, Patt M, Barthel H, Sabri O, Bartenstein P, Rominger A. Evaluation of early-phase [ 18F]-florbetaben PET acquisition in clinical routine cases. NEUROIMAGE-CLINICAL 2016; 14:77-86. [PMID: 28138429 PMCID: PMC5257027 DOI: 10.1016/j.nicl.2016.10.005] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 09/29/2016] [Accepted: 10/06/2016] [Indexed: 11/24/2022]
Abstract
Objectives In recent years several [18F]-labelled amyloid PET tracers have been developed and have obtained clinical approval. There is accumulating evidence that early (post injection) acquisitions with these tracers are equally informative as conventional blood flow and metabolism studies for diagnosis of Alzheimer's disease, but there have been few side-by-side studies. Therefore, we investigated the performance of early acquisitions of [18F]-florbetaben (FBB) PET compared to [18F]-fluorodeoxyglucose (FDG) PET in a clinical setting. Methods All subjects were recruited with clinical suspicion of dementia due to neurodegenerative disease. FDG PET was undertaken by conventional methods, and amyloid PET was performed with FBB, with early recordings for the initial 10 min (early-phase FBB), and late recordings at 90–110 min p.i. (late-phase FBB). Regional SUVR with cerebellar and global mean normalization were calculated for early-phase FBB and FDG PET. Pearson correlation coefficients between FDG and early-phase FBB were calculated for predefined cortical brain regions. Furthermore, a visual interpretation of disease pattern using 3-dimensional stereotactic surface projections (3D-SSP) was performed, with assessment of intra-reader agreement. Results Among a total of 33 patients (mean age 67.5 ± 11.0 years) included in the study, 18 were visually rated amyloid-positive, and 15 amyloid-negative based on late-phase FBB scans. Correlation coefficients for early-phase FBB vs. FDG scans displayed excellent agreement in all target brain regions for global mean normalization. Cerebellar normalization gave strong, but significantly lower correlations. 3D representations of early-phase FBB visually resembled the corresponding FDG PET images, irrespective of the amyloid-status of the late FBB scans. Conclusions Early-phase FBB acquisitions correlate on a relative quantitative and visual level with FDG PET scans, irrespective of the amyloid plaque density assessed in late FBB imaging. Thus, early-phase FBB uptake depicts a metabolism-like image, suggesting it as a valid surrogate marker for synaptic dysfunction, which could ultimately circumvent the need for additional FDG PET investigation in diagnosis of dementia. Early-phase [18F]-florbetaben uptake depicts a metabolism-like image Strong relative quantitative and visual correlations of early-phase [18F]-florbetaben uptake with FDG images A two-phase [18F]-florbetaben protocol might give combined neurodegeneration and amyloid pathology biomarker information Early-phase [18F]-florbetaben PET could ultimately circumvent the need for an additional FDG-PET in the dementia work-up.
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Key Words
- 3D-SSP, 3-dimensional stereotactic surface projections
- AD, Alzheimer's disease
- Alzheimer's disease
- CBF, cerebral blood flow
- CBL, cerebellum
- CN, cognitively normal
- FBB, [18F]florbetaben
- FDG Pet
- FDG, [18F]-fluorodeoxyglucose
- FTLD, frontotemporal lobar degeneration
- GLM, global mean
- L, left
- MCI, mild cognitive impairment
- MNI, Montreal Neurological Institute
- Metabolism
- PCC, posterior cingulate cortex
- PET, Positron emission tomography
- Perfusion
- R, right
- SPECT, single photon emission computed tomography
- SUVR, standardized uptake value ratio
- VOI, volume of interest
- [18F]-florbetaben PET
- p.i., post injection
- ß-amyloid
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Affiliation(s)
- Sonja Daerr
- Dept. of Nuclear Medicine, Ludwig-Maximilians-Universität München, München, Germany
| | - Matthias Brendel
- Dept. of Nuclear Medicine, Ludwig-Maximilians-Universität München, München, Germany
| | - Christian Zach
- Dept. of Nuclear Medicine, Ludwig-Maximilians-Universität München, München, Germany
| | - Erik Mille
- Dept. of Nuclear Medicine, Ludwig-Maximilians-Universität München, München, Germany
| | - Dorothee Schilling
- Dept. of Nuclear Medicine, Ludwig-Maximilians-Universität München, München, Germany
| | | | - Katharina Bürger
- ISD, Ludwig-Maximilians-Universität München, München, Germany; German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Adrian Danek
- Dept. of Neurology, Ludwig-Maximilians-Universität München, München, Germany
| | - Oliver Pogarell
- Dept. of Psychiatry, Ludwig-Maximilians-Universität München, München, Germany
| | - Andreas Schildan
- Dept. of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Marianne Patt
- Dept. of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Henryk Barthel
- Dept. of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Osama Sabri
- Dept. of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Peter Bartenstein
- Dept. of Nuclear Medicine, Ludwig-Maximilians-Universität München, München, Germany; SyNergy, Ludwig-Maximilians-Universität München, München, Germany
| | - Axel Rominger
- Dept. of Nuclear Medicine, Ludwig-Maximilians-Universität München, München, Germany; SyNergy, Ludwig-Maximilians-Universität München, München, Germany
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14
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Eisenmenger LB, Huo EJ, Hoffman JM, Minoshima S, Matesan MC, Lewis DH, Lopresti BJ, Mathis CA, Okonkwo DO, Mountz JM. Advances in PET Imaging of Degenerative, Cerebrovascular, and Traumatic Causes of Dementia. Semin Nucl Med 2016; 46:57-87. [DOI: 10.1053/j.semnuclmed.2015.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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15
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Is there a preference for PET or SPECT brain imaging in diagnosing dementia? The views of people with dementia, carers, and healthy controls. Int Psychogeriatr 2016; 28:123-31. [PMID: 26174876 DOI: 10.1017/s1041610215001039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Positron emission tomography (PET) and single photon emission computed tomography (SPECT) brain imaging are widely used as diagnostic tools for suspected dementia but no studies have directly compared participant views of the two procedures. We used a range of methods to explore preferences for PET and SPECT. METHODS Patients and controls (and accompanying carers) completed questionnaires immediately after undergoing PET and SPECT brain scans. Pulse rate data were collected during each scan. Scan attributes were prioritized using a card sorting exercise; carers and controls additionally answered willingness to pay (WTP) questions. RESULTS Few differences were found either between the scans or groups of participants, although carers marginally preferred SPECT. Diagnostic accuracy was prioritized over other scan characteristics. Mean heart rate during both scans was lower than baseline heart rate measured at home (p < 0.001). CONCLUSION Most participants viewed PET and SPECT scans as roughly equivalent and did not have a preference for either scan. Carer preference for SPECT is likely to reflect their desire to be with the patient (routine practice for SPECT but not for PET), suggesting that they should be able to accompany vulnerable patients throughout imaging procedures wherever possible. Pulse rate data indicated that brain imaging was no more stressful than a home visit (HV) from a researcher. The data do not support the anecdotal view that PET is a more burdensome procedure and the use of PET or SPECT scans in dementia should be based on diagnostic accuracy of the technique.
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16
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Regional cerebral blood flow estimated by early PiB uptake is reduced in mild cognitive impairment and associated with age in an amyloid-dependent manner. Neurobiol Aging 2015; 36:1619-1628. [PMID: 25702957 DOI: 10.1016/j.neurobiolaging.2014.12.036] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 12/22/2014] [Accepted: 12/26/2014] [Indexed: 12/16/2022]
Abstract
Early uptake of [(11)C]-Pittsburgh Compound B (ePiB, 0-6 minutes) estimates cerebral blood flow. We studied ePiB in 13 PiB-negative and 10 PiB-positive subjects with mild cognitive impairment (MCI, n = 23) and 11 PiB-positive and 74 PiB-negative cognitively healthy elderly control subjects (HCS, n = 85) in 6 bilateral volumes of interest: posterior cingulate cortex (PCC), hippocampus (hipp), temporoparietal region, superior parietal gyrus, parahippocampal gyrus (parahipp), and inferior frontal gyrus (IFG) for the associations with cognitive status, age, amyloid deposition, and apolipoprotein E ε4-allele. We observed no difference in ePiB between PiB-positive and -negative subjects and carriers and noncarriers. EPiB decreased with age in PiB-positive subjects in bilateral superior parietal gyrus, bilateral temporoparietal region, right IFG, right PCC, and left parahippocampal gyrus but not in PiB-negative subjects. MCI had lower ePiB than HCS (left PCC, left IFG, and left and right hipp). Lowest ePiB values were found in MCI of 70 years and older, who also displayed high cortical PiB binding. This suggests that lowered regional cerebral blood flow indicated by ePiB is associated with age in the presence but not in the absence of amyloid pathology.
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17
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Nasrallah IM, Wolk DA. Multimodality imaging of Alzheimer disease and other neurodegenerative dementias. J Nucl Med 2014; 55:2003-11. [PMID: 25413136 DOI: 10.2967/jnumed.114.141416] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Neurodegenerative diseases, such as Alzheimer disease, result in cognitive decline and dementia and are a leading cause of mortality in the growing elderly population. These progressive diseases typically have an insidious onset, with overlapping clinical features early in the disease course that make diagnosis challenging. The neurodegenerative diseases are associated with characteristic, although not completely understood, changes in the brain: abnormal protein deposition, synaptic dysfunction, neuronal injury, and neuronal death. Neuroimaging biomarkers-principally regional atrophy on structural MR imaging, patterns of hypometabolism on (18)F-FDG PET, and detection of cerebral amyloid plaque on amyloid PET--are able to evaluate the patterns of these abnormalities in the brain to improve early diagnosis and help predict the disease course. These techniques have unique strengths and synergies in multimodality evaluation of the patient with cognitive decline or dementia. This review discusses the key imaging biomarkers from MR imaging, (18)F-FDG PET, and amyloid PET; the imaging features of the most common neurodegenerative dementias; the role of various neuroimaging studies in differential diagnosis and prognosis; and some promising imaging techniques under development.
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Affiliation(s)
- Ilya M Nasrallah
- Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David A Wolk
- Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, Pennsylvania
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18
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Davison CM, O'Brien JT. A comparison of FDG-PET and blood flow SPECT in the diagnosis of neurodegenerative dementias: a systematic review. Int J Geriatr Psychiatry 2014; 29:551-61. [PMID: 24123413 DOI: 10.1002/gps.4036] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 09/16/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Perfusion single photon emission computed tomography (SPECT) and 18F fluorodeoxyglucose positron emission tomography (FDG-PET) both have clinical utility for the differential diagnosis of dementia. Although PET is often viewed by some as more accurate and therefore preferential, the extent to which published evidence supports this is not clear. The aim of this review was to address the question by reviewing studies of SPECT and PET imaging in dementia diagnosis, with a particular focus on all published head-to-head studies. DESIGN A MEDLINE search was carried out using the following keywords: "PET" and "SPECT" and "dementia" or "Mild Cognitive Impairment," together with "alzheimers" or "DLB" or "lewy body" or "frontotemporal" or "FTD" or "Picks." Articles were included up to February 2013, limited to human studies and in English language. RESULTS Published studies of SPECT accuracy show that it is a useful tool for differential diagnosis, with sensitivities of 65-85% for diagnosing Alzheimer's disease (AD) and specificities (for other neurodegenerative dementias) of 72-87%. PET studies generally report higher accuracy, with sensitivities of 75-99% for AD and specificities of 71-93%. However, there have been few direct head-to-head comparisons, with some indicating SPECT and PET to be equally useful in dementia diagnosis and others favouring PET. Many of these studies are limited with respect to numbers and methodically with poorly matched control groups. CONCLUSIONS Overall, although studies suggest superiority of PET over SPECT, the evidence base for this is actually quite limited. We suggest that further direct comparative studies, including health economic and patient preference evaluations, are needed to help direct future service provision.
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19
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Computer-assisted system for diagnosing degenerative dementia using cerebral blood flow SPECT and 3D-SSP: a multicenter study. Jpn J Radiol 2014; 32:383-90. [DOI: 10.1007/s11604-014-0329-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 04/16/2014] [Indexed: 11/27/2022]
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20
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Brown RKJ, Bohnen NI, Wong KK, Minoshima S, Frey KA. Brain PET in Suspected Dementia: Patterns of Altered FDG Metabolism. Radiographics 2014; 34:684-701. [DOI: 10.1148/rg.343135065] [Citation(s) in RCA: 147] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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21
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Abstract
FDG-PET is a valuable tool that will continue to aid in identifying AD in its prodromal and early dementia stages, distinguishing it from other causes of dementia, and tracking progression of the disease. As brain FDG-PET scans and well-trained readers of these scans are becoming more widely available to clinicians who are becoming more informed about the role FDG-PET can play in early AD diagnosis, its use is expected to increase.
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Affiliation(s)
- Jessica Chew
- Ahmanson Translational Imaging Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at University of California, Los Angeles, CA 90095-7370, USA
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22
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Torosyan N, Silverman DHS. Neuronuclear imaging in the evaluation of dementia and mild decline in cognition. Semin Nucl Med 2013; 42:415-22. [PMID: 23026363 DOI: 10.1053/j.semnuclmed.2012.06.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Recently, the National Institute on Aging and the Alzheimer's Association identified specific structural and functional neuroimaging findings as valuable markers of biological processes occurring in the human brain, especially processes that herald impending dementia caused by Alzheimer's disease (AD) in its prodromal form. In particular, the imaging modalities of magnetic resonance imaging and positron emission tomography (PET) were singled out, along with certain biomarkers in cerebrospinal fluid, to serve this purpose. We review the clinical tests available for neuropsychologic evaluation and in cases when the differential diagnosis for the causes of cognitive impairment is difficult to make, we consider biomarkers, beginning with cerebrospinal fluid, for assessment of cognitive decline. For more direct information on dementia-related pathologic changes in brain tissue, structural features observed in magnetic resonance imaging scans are regarded. We next discuss the use of single-photon emission computed tomography for evaluating functional changes. Then, pertinent to the recent National Institute on Aging and the Alzheimer's Association's consensus statement on the diagnosis of prodromal AD, we focus on assessing the cerebral metabolic changes associated with neurodegenerative diseases that are identified with fluorodeoxyglucose PET, as well as consider the most appropriate roles for amyloid imaging based on recent studies examining the use of PET with tracers having higher retention in brain tissue-harboring plaques composed of insoluble beta-amyloid. We also consider the leading causes for the current underuse of neuronuclear imaging in evaluating patients with cognitive problems, along with strategies for combating them. Finally, we suggest an overall diagnostic algorithm to guide optimal use of all the neuroimaging tools in assessing patients with cognitive decline.
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Affiliation(s)
- Nare Torosyan
- Ahmanson Translational Imaging Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at the University of California, Los Angeles, CA 90095-7370, USA
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23
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The diagnosis and evaluation of dementia and mild cognitive impairment with emphasis on SPECT perfusion neuroimaging. CNS Spectr 2012; 17:176-206. [PMID: 22929226 DOI: 10.1017/s1092852912000636] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
As the world population ages, the incidence of dementing illnesses will dramatically increase. The number of people afflicted with dementia is expected to quadruple in the next 50 years. Since the neuropathology of the dementias precedes clinical symptoms often by several years, earlier detection and intervention could be key steps to mitigating the progression and burden of these diseases. This review will explore methods of evaluating, differentiating, and diagnosing the multiple forms of dementia. Particular emphasis will be placed on the diagnosis of mild cognitive impairment-the precursor to dementia. Anatomical imaging; cerebrospinal fluid markers; functional neuroimaging, such as positron emission tomography and single photon emission tomography; and molecular imaging, such as amyloid marker imaging, will be assessed in terms of sensitivity and specificity. Cost will also be a consideration, as the growing population afflicted with dementia represents an increasingly large financial encumbrance to the healthcare systems of every nation. In the face of expensive new markers and limited availability of cyclotrons, single photon emission computer tomography (SPECT) provides relatively high sensitivity and specificity at a comparatively low overall cost.
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Darvesh S. Butyrylcholinesterase radioligands to image Alzheimer's disease brain. Chem Biol Interact 2012; 203:354-7. [PMID: 22935510 DOI: 10.1016/j.cbi.2012.08.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 08/02/2012] [Accepted: 08/03/2012] [Indexed: 11/29/2022]
Abstract
Butyrylcholinesterase (BuChE) is found to have a brain distribution pattern that is distinct from that of acetylcholinesterase (AChE). Neurons containing BuChE are particularly located in the amygdala, hippocampal formation and the thalamus, structures involved in the normal functions of cognition and behavior that typically become compromised in Alzheimer's disease (AD). Progress of this disease is thought to result, at least in part, from the accumulation of β-amyloid (Aβ) plaques and neurofibrillary tangles (NFTs) in the brain. These structures characteristically become associated with cholinesterase activity, and are major determinants of AD diagnosis post-mortem. Early definitive AD diagnosis in the living brain could greatly facilitate specific timely treatment of the disorder and the search for novel drugs to preempt progress of this disease. Radioligands have been developed to detect deposition of Aβ plaques in the brain; however, since many cognitively normal individuals also exhibit Aβ plaque deposition, this approach has inherent disadvantages for definitive AD diagnosis during life. The association of BuChE with Aβ plaques appears to be a characteristic of AD. This has prompted the search for radioligands that target BuChE in association with Aβ plaques that accumulate in cortical grey matter, a region normally with very little of this enzyme activity. A number of BuChE radioligands have been synthesized and preliminary testing indicates that some such radioligands enter the brain and accumulate in regions known to contain BuChE. Radioligands targeting unusual BuChE activity in the brain may represent a means for early diagnosis and treatment monitoring of AD.
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Affiliation(s)
- Sultan Darvesh
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
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