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Swinford CG, Risacher SL, Wu YC, Apostolova LG, Gao S, Bice PJ, Saykin AJ. Altered cerebral blood flow in older adults with Alzheimer's disease: a systematic review. Brain Imaging Behav 2023; 17:223-256. [PMID: 36484922 PMCID: PMC10117447 DOI: 10.1007/s11682-022-00750-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 09/26/2022] [Accepted: 11/20/2022] [Indexed: 12/13/2022]
Abstract
The prevalence of Alzheimer's disease is projected to reach 13 million in the U.S. by 2050. Although major efforts have been made to avoid this outcome, so far there are no treatments that can stop or reverse the progressive cognitive decline that defines Alzheimer's disease. The utilization of preventative treatment before significant cognitive decline has occurred may ultimately be the solution, necessitating a reliable biomarker of preclinical/prodromal disease stages to determine which older adults are most at risk. Quantitative cerebral blood flow is a promising potential early biomarker for Alzheimer's disease, but the spatiotemporal patterns of altered cerebral blood flow in Alzheimer's disease are not fully understood. The current systematic review compiles the findings of 81 original studies that compared resting gray matter cerebral blood flow in older adults with mild cognitive impairment or Alzheimer's disease and that of cognitively normal older adults and/or assessed the relationship between cerebral blood flow and objective cognitive function. Individuals with Alzheimer's disease had relatively decreased cerebral blood flow in all brain regions investigated, especially the temporoparietal and posterior cingulate, while individuals with mild cognitive impairment had consistent results of decreased cerebral blood flow in the posterior cingulate but more mixed results in other regions, especially the frontal lobe. Most papers reported a positive correlation between regional cerebral blood flow and cognitive function. This review highlights the need for more studies assessing cerebral blood flow changes both spatially and temporally over the course of Alzheimer's disease, as well as the importance of including potential confounding factors in these analyses.
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Affiliation(s)
- Cecily G Swinford
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 355 W 16th St. IU Neuroscience Center, GH 4101, 46202, Indianapolis, IN, USA
- Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Shannon L Risacher
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 355 W 16th St. IU Neuroscience Center, GH 4101, 46202, Indianapolis, IN, USA
- Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Yu-Chien Wu
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 355 W 16th St. IU Neuroscience Center, GH 4101, 46202, Indianapolis, IN, USA
- Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Liana G Apostolova
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 355 W 16th St. IU Neuroscience Center, GH 4101, 46202, Indianapolis, IN, USA
- Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sujuan Gao
- Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Paula J Bice
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 355 W 16th St. IU Neuroscience Center, GH 4101, 46202, Indianapolis, IN, USA
- Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Andrew J Saykin
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 355 W 16th St. IU Neuroscience Center, GH 4101, 46202, Indianapolis, IN, USA.
- Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, USA.
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA.
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Faria DDP, Duran FL, Squarzoni P, Coutinho AM, Garcez AT, Santos PP, Brucki SM, de Oliveira MO, Trés ES, Forlenza OV, Nitrini R, Buchpiguel CA, Busatto Filho G. Topography of 11C-Pittsburgh compound B uptake in Alzheimer's disease: a voxel-based investigation of cortical and white matter regions. ACTA ACUST UNITED AC 2018; 41:101-111. [PMID: 30540022 PMCID: PMC6781685 DOI: 10.1590/1516-4446-2017-0002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 07/06/2018] [Indexed: 01/09/2023]
Abstract
Objective: To compare results of positron emission tomography (PET) with carbon-11-labeled Pittsburgh compound B (11C-PIB) obtained with cerebellar or global brain uptake for voxel intensity normalization, describe the cortical sites with highest tracer uptake in subjects with mild Alzheimer’s disease (AD), and explore possible group differences in 11C-PIB binding to white matter. Methods: 11C-PIB PET scans were acquired from subjects with AD (n=17) and healthy elderly controls (n=19). Voxel-based analysis was performed with statistical parametric mapping (SPM). Results: Cerebellar normalization showed higher 11C-PIB uptake in the AD group relative to controls throughout the cerebral cortex, involving the lateral temporal, orbitofrontal, and superior parietal cortices. With global uptake normalization, greatest cortical binding was detected in the orbitofrontal cortex; decreased 11C-PIB uptake in white matter was found in the posterior hippocampal region, corpus callosum, pons, and internal capsule. Conclusion: The present case-control voxelwise 11C-PIB PET comparison highlighted the regional distribution of amyloid deposition in the cerebral cortex of mildly demented AD patients. Tracer uptake was highest in the orbitofrontal cortex. Decreased 11C-PIB uptake in white-matter regions in this patient population may be a marker of white-matter damage in AD.
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Affiliation(s)
- Daniele de P Faria
- Laboratório de Medicina Nuclear (LIM 43), Departamento de Radiologia e Oncologia, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.,Núcleo de Apoio à Pesquisa em Neurociência Aplicada (NAPNA), USP, São Paulo, SP, Brazil
| | - Fabio L Duran
- Núcleo de Apoio à Pesquisa em Neurociência Aplicada (NAPNA), USP, São Paulo, SP, Brazil.,Laboratório de Neuroimagem em Psiquiatria (LIM 21), Departamento de Psiquiatria, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Paula Squarzoni
- Núcleo de Apoio à Pesquisa em Neurociência Aplicada (NAPNA), USP, São Paulo, SP, Brazil.,Laboratório de Neuroimagem em Psiquiatria (LIM 21), Departamento de Psiquiatria, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Artur M Coutinho
- Laboratório de Medicina Nuclear (LIM 43), Departamento de Radiologia e Oncologia, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.,Núcleo de Apoio à Pesquisa em Neurociência Aplicada (NAPNA), USP, São Paulo, SP, Brazil
| | - Alexandre T Garcez
- Laboratório de Medicina Nuclear (LIM 43), Departamento de Radiologia e Oncologia, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.,Núcleo de Apoio à Pesquisa em Neurociência Aplicada (NAPNA), USP, São Paulo, SP, Brazil
| | - Pedro P Santos
- Núcleo de Apoio à Pesquisa em Neurociência Aplicada (NAPNA), USP, São Paulo, SP, Brazil.,Laboratório de Neuroimagem em Psiquiatria (LIM 21), Departamento de Psiquiatria, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Sonia M Brucki
- Departamento de Neurologia, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Maira O de Oliveira
- Departamento de Neurologia, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Eduardo S Trés
- Departamento de Neurologia, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Orestes V Forlenza
- Núcleo de Apoio à Pesquisa em Neurociência Aplicada (NAPNA), USP, São Paulo, SP, Brazil.,Laboratório de Neurociências (LIM 27), Departamento de Psiquiatria, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Ricardo Nitrini
- Departamento de Neurologia, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Carlos A Buchpiguel
- Laboratório de Medicina Nuclear (LIM 43), Departamento de Radiologia e Oncologia, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.,Núcleo de Apoio à Pesquisa em Neurociência Aplicada (NAPNA), USP, São Paulo, SP, Brazil
| | - Geraldo Busatto Filho
- Núcleo de Apoio à Pesquisa em Neurociência Aplicada (NAPNA), USP, São Paulo, SP, Brazil.,Laboratório de Neuroimagem em Psiquiatria (LIM 21), Departamento de Psiquiatria, Faculdade de Medicina, USP, São Paulo, SP, Brazil
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Rondina JM, Ferreira LK, de Souza Duran FL, Kubo R, Ono CR, Leite CC, Smid J, Nitrini R, Buchpiguel CA, Busatto GF. Selecting the most relevant brain regions to discriminate Alzheimer's disease patients from healthy controls using multiple kernel learning: A comparison across functional and structural imaging modalities and atlases. Neuroimage Clin 2017; 17:628-641. [PMID: 29234599 PMCID: PMC5716956 DOI: 10.1016/j.nicl.2017.10.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 10/12/2017] [Accepted: 10/24/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Machine learning techniques such as support vector machine (SVM) have been applied recently in order to accurately classify individuals with neuropsychiatric disorders such as Alzheimer's disease (AD) based on neuroimaging data. However, the multivariate nature of the SVM approach often precludes the identification of the brain regions that contribute most to classification accuracy. Multiple kernel learning (MKL) is a sparse machine learning method that allows the identification of the most relevant sources for the classification. By parcelating the brain into regions of interest (ROI) it is possible to use each ROI as a source to MKL (ROI-MKL). METHODS We applied MKL to multimodal neuroimaging data in order to: 1) compare the diagnostic performance of ROI-MKL and whole-brain SVM in discriminating patients with AD from demographically matched healthy controls and 2) identify the most relevant brain regions to the classification. We used two atlases (AAL and Brodmann's) to parcelate the brain into ROIs and applied ROI-MKL to structural (T1) MRI, 18F-FDG-PET and regional cerebral blood flow SPECT (rCBF-SPECT) data acquired from the same subjects (20 patients with early AD and 18 controls). In ROI-MKL, each ROI received a weight (ROI-weight) that indicated the region's relevance to the classification. For each ROI, we also calculated whether there was a predominance of voxels indicating decreased or increased regional activity (for 18F-FDG-PET and rCBF-SPECT) or volume (for T1-MRI) in AD patients. RESULTS Compared to whole-brain SVM, the ROI-MKL approach resulted in better accuracies (with either atlas) for classification using 18F-FDG-PET (92.5% accuracy for ROI-MKL versus 84% for whole-brain), but not when using rCBF-SPECT or T1-MRI. Although several cortical and subcortical regions contributed to discrimination, high ROI-weights and predominance of hypometabolism and atrophy were identified specially in medial parietal and temporo-limbic cortical regions. Also, the weight of discrimination due to a pattern of increased voxel-weight values in AD individuals was surprisingly high (ranging from approximately 20% to 40% depending on the imaging modality), located mainly in primary sensorimotor and visual cortices and subcortical nuclei. CONCLUSION The MKL-ROI approach highlights the high discriminative weight of a subset of brain regions of known relevance to AD, the selection of which contributes to increased classification accuracy when applied to 18F-FDG-PET data. Moreover, the MKL-ROI approach demonstrates that brain regions typically spared in mild stages of AD also contribute substantially in the individual discrimination of AD patients from controls.
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Key Words
- 18F-FDG-PET, 18F-Fluorodeoxyglucose-Positron Emission Tomography
- AAL, Automated Anatomical Labeling (atlas)
- AD, Alzheimer's Disease
- Alzheimer's Disease
- BA, Brodmann's Area
- Brain atlas
- GM, Gray Matter
- MKL, Multiple Kernel Learning
- MKL-ROI, MKL based on regions of interest
- ML, Machine Learning
- MRI
- Multiple kernel learning
- NF, number of features
- NSR, Number of Selected Regions
- PET
- PVE, Partial Volume Effects
- ROI, Region of Interest
- SPECT
- SVM, Support Vector Machine
- T1-MRI, T1-weighted Magnetic Resonance Imaging
- TN, True Negative (specificity - proportion of healthy controls correctly classified)
- TP, True Positive (sensitivity - proportion of patients correctly classified)
- rAUC, Ratio between negative and positive Area Under Curve
- rCBF-SPECT, Regional Cerebral Blood Flow
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Affiliation(s)
- Jane Maryam Rondina
- Laboratory of Psychiatric Neuroimaging (LIM 21), Department of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil; Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK.
| | - Luiz Kobuti Ferreira
- Laboratory of Psychiatric Neuroimaging (LIM 21), Department of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil; Núcleo de Apoio à Pesquisa em Neurociência Aplicada (NAPNA), University of São Paulo, São Paulo, Brazil
| | - Fabio Luis de Souza Duran
- Laboratory of Psychiatric Neuroimaging (LIM 21), Department of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Rodrigo Kubo
- Department of Radiology and Oncology, University of São Paulo Medical School, São Paulo, Brazil
| | - Carla Rachel Ono
- Department of Radiology and Oncology, University of São Paulo Medical School, São Paulo, Brazil
| | - Claudia Costa Leite
- Department of Radiology and Oncology, University of São Paulo Medical School, São Paulo, Brazil; Department of Radiology, University of North Carolina at Chapel Hill, NC, USA
| | - Jerusa Smid
- Department of Neurology and Cognitive Disorders Reference Center (CEREDIC), University of São Paulo, São Paulo, Brazil
| | - Ricardo Nitrini
- Department of Neurology and Cognitive Disorders Reference Center (CEREDIC), University of São Paulo, São Paulo, Brazil
| | | | - Geraldo F Busatto
- Laboratory of Psychiatric Neuroimaging (LIM 21), Department of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil; Núcleo de Apoio à Pesquisa em Neurociência Aplicada (NAPNA), University of São Paulo, São Paulo, Brazil; Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
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Ferreira LK, Rondina JM, Kubo R, Ono CR, Leite CC, Smid J, Bottino C, Nitrini R, Busatto GF, Duran FL, Buchpiguel CA. Support vector machine-based classification of neuroimages in Alzheimer's disease: direct comparison of FDG-PET, rCBF-SPECT and MRI data acquired from the same individuals. ACTA ACUST UNITED AC 2017; 40:181-191. [PMID: 28977066 PMCID: PMC6900774 DOI: 10.1590/1516-4446-2016-2083] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 05/08/2017] [Indexed: 12/01/2022]
Abstract
Objective: To conduct the first support vector machine (SVM)-based study comparing the diagnostic accuracy of T1-weighted magnetic resonance imaging (T1-MRI), F-fluorodeoxyglucose-positron emission tomography (FDG-PET) and regional cerebral blood flow single-photon emission computed tomography (rCBF-SPECT) in Alzheimer’s disease (AD). Method: Brain T1-MRI, FDG-PET and rCBF-SPECT scans were acquired from a sample of mild AD patients (n=20) and healthy elderly controls (n=18). SVM-based diagnostic accuracy indices were calculated using whole-brain information and leave-one-out cross-validation. Results: The accuracy obtained using PET and SPECT data were similar. PET accuracy was 68∼71% and area under curve (AUC) 0.77∼0.81; SPECT accuracy was 68∼74% and AUC 0.75∼0.79, and both had better performance than analysis with T1-MRI data (accuracy of 58%, AUC 0.67). The addition of PET or SPECT to MRI produced higher accuracy indices (68∼74%; AUC: 0.74∼0.82) than T1-MRI alone, but these were not clearly superior to the isolated neurofunctional modalities. Conclusion: In line with previous evidence, FDG-PET and rCBF-SPECT more accurately identified patients with AD than T1-MRI, and the addition of either PET or SPECT to T1-MRI data yielded increased accuracy. The comparable SPECT and PET performances, directly demonstrated for the first time in the present study, support the view that rCBF-SPECT still has a role to play in AD diagnosis.
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Affiliation(s)
- Luiz K Ferreira
- Laboratório de Neuroimagem em Psiquiatria (LIM21), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.,Núcleo de Apoio à Pesquisa em Neurociência Aplicada (NAPNA), USP, São Paulo, SP, Brazil
| | - Jane M Rondina
- Laboratório de Neuroimagem em Psiquiatria (LIM21), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.,Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
| | - Rodrigo Kubo
- Laboratório de Medicina Nuclear (LIM43), Departamento de Radiologia e Oncologia, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Carla R Ono
- Laboratório de Medicina Nuclear (LIM43), Departamento de Radiologia e Oncologia, Faculdade de Medicina, USP, São Paulo, SP, Brazil.,Serviço de Medicina Nuclear, Hospital do Coração da Associação Sanatório Sírio, São Paulo, SP, Brazil
| | - Claudia C Leite
- Departamento de Radiologia e Oncologia, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Jerusa Smid
- Departamento de Neurologia, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Cassio Bottino
- Departamento de Psiquiatria, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Ricardo Nitrini
- Departamento de Neurologia, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Geraldo F Busatto
- Laboratório de Neuroimagem em Psiquiatria (LIM21), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.,Núcleo de Apoio à Pesquisa em Neurociência Aplicada (NAPNA), USP, São Paulo, SP, Brazil.,Departamento de Psiquiatria, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Fabio L Duran
- Laboratório de Neuroimagem em Psiquiatria (LIM21), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.,Núcleo de Apoio à Pesquisa em Neurociência Aplicada (NAPNA), USP, São Paulo, SP, Brazil
| | - Carlos A Buchpiguel
- Núcleo de Apoio à Pesquisa em Neurociência Aplicada (NAPNA), USP, São Paulo, SP, Brazil.,Laboratório de Medicina Nuclear (LIM43), Departamento de Radiologia e Oncologia, Faculdade de Medicina, USP, São Paulo, SP, Brazil.,Serviço de Medicina Nuclear, Hospital do Coração da Associação Sanatório Sírio, São Paulo, SP, Brazil
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5
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Welz F, Sanders JC, Kuwert T, Maler J, Kornhuber J, Ritt P. Absolute SPECT/CT quantification of cerebral uptake of 99mTc-HMPAO for patients with neurocognitive disorders. Nuklearmedizin 2016; 55:158-65. [PMID: 26690261 DOI: 10.3413/nukmed-0765-15-09] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 12/01/2015] [Indexed: 12/27/2022]
Abstract
UNLABELLED It was reported from planar imaging studies that the cerebral uptake of injected 99mTc-HMPAO activity is about 4-7% in humans. Recent work has shown that modern SPECT/CT devices are able to quantify the tissue concentration of radioactivity in vivo in absolute units (Bq/ml), while avoiding the limitations of planar techniques. The aims of this study were (a) to determine the cerebral uptake of 99mTc-HMPAO in absolute units in SPECT/CT, (b) to investigate potential differences in absolute tracer uptake for patients suspected of dementia. PATIENTS, METHODS We performed 99mTc-HMPAO SPECT/CT in 65 patients with suspected dementia. 99mTc-HMPAO uptake was determined using a previously published quantitative SPECT/CT protocol. The absolute HMPAO uptake and the results of a regionalized analysis were compared for MMSE and NINCDS-ADRDA based patient groups. RESULTS The mean absolute uptake of 99mTc-HMPAO for our patient population was 4.3 ± 0.8% of the injected dose. The uptake, as well as the regionalized analysis yielded significantly different results for low (≤23) and high (>23) MMSE groups and also for some of the NINCDS-ADRDA groups. CONCLUSION Our results show that the absolute cerebral uptake of 99mTc-HMPAO is in the range of previously reported results, obtained by planar techniques. Absolute uptake is significantly different between the patient groups.
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Affiliation(s)
| | | | | | | | | | - Philipp Ritt
- Philipp Ritt, PhD, Clinic of Nuclear Medicine, Ulmenweg 18, 91054 Erlangen, Germany, Tel. +49/(0)91 31/853-34 11, Fax -92 62,
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Deo AK, Borson S, Link JM, Domino K, Eary JF, Ke B, Richards TL, Mankoff DA, Minoshima S, O'Sullivan F, Eyal S, Hsiao P, Maravilla K, Unadkat JD. Activity of P-Glycoprotein, a β-Amyloid Transporter at the Blood-Brain Barrier, Is Compromised in Patients with Mild Alzheimer Disease. J Nucl Med 2014; 55:1106-11. [PMID: 24842892 DOI: 10.2967/jnumed.113.130161] [Citation(s) in RCA: 136] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 03/17/2014] [Indexed: 12/16/2022] Open
Abstract
UNLABELLED Studies in animals and postmortem human brain tissue support a role for P-glycoprotein in clearance of cerebral β-amyloid across the blood-brain barrier (BBB). We tested the hypothesis that BBB P-glycoprotein activity is diminished in Alzheimer disease (AD) by accounting for an AD-related reduction in regional cerebral blood flow (rCBF). METHODS We compared P-glycoprotein activity in mild-AD patients (n = 9) and cognitively normal, age-matched controls (n = 9) using PET with a labeled P-glycoprotein substrate, (11)C-verapamil, and (15)O-water to measure rCBF. BBB P-glycoprotein activity was expressed as the (11)C-verapamil radioactivity extraction ratio ((11)C-verapamil brain distributional clearance, K1/rCBF). RESULTS Compared with controls, BBB P-glycoprotein activity was significantly lower in the parietotemporal, frontal, and posterior cingulate cortices and hippocampus of mild AD subjects. CONCLUSION BBB P-glycoprotein activity in brain regions affected by AD is reduced and is independent of rCBF. This study improves on prior work by eliminating the confounding effect that reduced rCBF has on assessment of BBB P-glycoprotein activity and suggests that impaired P-glycoprotein activity may contribute to cerebral β-amyloid accumulation in AD. P-glycoprotein induction or activation to increase cerebral β-amyloid clearance could constitute a novel preventive or therapeutic strategy for AD.
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Affiliation(s)
- Anand K Deo
- Department of Pharmaceutics, University of Washington, Seattle, Washington
| | - Soo Borson
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Jeanne M Link
- Department of Radiology, University of Washington, Seattle, Washington
| | - Karen Domino
- Department of Anesthesiology, University of Washington, Seattle, Washington; and
| | - Janet F Eary
- Department of Radiology, University of Washington, Seattle, Washington
| | - Ban Ke
- Department of Pharmaceutics, University of Washington, Seattle, Washington
| | - Todd L Richards
- Department of Radiology, University of Washington, Seattle, Washington
| | - David A Mankoff
- Department of Radiology, University of Washington, Seattle, Washington
| | - Satoshi Minoshima
- Department of Radiology, University of Washington, Seattle, Washington
| | - Finbarr O'Sullivan
- Department of Radiology, University of Washington, Seattle, Washington Department of Statistics, University College Cork, Cork, Ireland
| | - Sara Eyal
- Department of Pharmaceutics, University of Washington, Seattle, Washington
| | - Peng Hsiao
- Department of Pharmaceutics, University of Washington, Seattle, Washington
| | - Ken Maravilla
- Department of Radiology, University of Washington, Seattle, Washington
| | - Jashvant D Unadkat
- Department of Pharmaceutics, University of Washington, Seattle, Washington
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7
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Cho H, Kwon JH, Seo HJ, Kim JS. The short-term effect of acetylcholinesterase inhibitor on the regional cerebral blood flow of Alzheimer's disease. Arch Gerontol Geriatr 2010; 50:222-6. [DOI: 10.1016/j.archger.2009.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Revised: 03/19/2009] [Accepted: 03/24/2009] [Indexed: 11/26/2022]
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8
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Staffen W, Bergmann J, Schönauer U, Zauner H, Kronbichler M, Golaszewski S, Ladurner G. Cerebral perfusion (HMPAO-SPECT) in patients with depression with cognitive impairment versus those with mild cognitive impairment and dementia of Alzheimer's type: a semiquantitative and automated evaluation. Eur J Nucl Med Mol Imaging 2009; 36:801-10. [PMID: 19137294 DOI: 10.1007/s00259-008-1028-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Accepted: 11/21/2008] [Indexed: 02/07/2023]
Abstract
PURPOSE Comparative evaluation of regional brain perfusion measured by HMPAO-SPECT of patients with mild cognitive impairment (MCI), dementia of Alzheimer's type (DAT) and depression with cognitive impairment (DCI). METHODS A total of 736 patients were investigated because of suspected cognitive dysfunction. After exclusion of patients with other forms of dementia than DAT or relevant accompanying disorders, SPECT data from 149 MCI, 131 DAT and 127 DCI patients, and 123 controls without any cognitive impairment, were analysed. Relative cerebral blood flow of 34 anatomical regions was assessed with automated analysis software (BRASS). RESULTS Calculation of global forebrain perfusion discriminated demented from nondemented patients. Compared to controls DCI patients showed hypoperfusion of the thalamus, lentiform nucleus and medial temporal cortex. MCI patients differed significantly from controls concerning perfusion in both hemispheric temporal and parietal areas, and in the (right hemispheric) posterior part of the cingulate gyrus. MCI and DCI patients differed in the parietal, temporal superior and right hemispheric cingulate gyrus posterior cortices. Global forebrain and regional perfusion was more extensively reduced in DAT patients and discriminated them from controls, and MCI and DCI patients. Frontal perfusion disturbance was only present in DAT patients. CONCLUSION Automated analysis of HMPAO-SPECT data from MCI patients showed significant perfusion deficits in regions also involved in DAT patients, but ROC analysis demonstrated only moderate sensitivity and specificity for differentiating DAT patients from controls and DCI patients. Frontal hypoperfusion seems to correspond with conversion from MCI to DAT. Finally, the results in DCI patients again raise the question of depression as an early symptom of neurodegeneration.
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Affiliation(s)
- W Staffen
- Christian-Doppler-Clinic, Department of Neurology, Paracelsus Medical University, Salzburg, Austria.
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9
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Ladeira RB, Diniz BS, Nunes PV, Forlenza OV. Combining cognitive screening tests for the evaluation of mild cognitive impairment in the elderly. Clinics (Sao Paulo) 2009; 64:967-73. [PMID: 19841703 PMCID: PMC2763071 DOI: 10.1590/s1807-59322009001000006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Accepted: 07/13/2009] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To determine the accuracy of the Mini-Mental State Examination combined with the Verbal Fluency Test and Clock Drawing Test for the identification of patients with mild cognitive impairment and Alzheimer's disease (AD). METHOD These tests were used to evaluate cognitive function in 247 older adults. Subjects were divided into three groups according to their cognitive state: mild cognitive impairment (n=83), AD (n=81), cognitively unimpaired controls (n=83), based on clinical and neuropsychological data. The diagnostic accuracy of each test for discriminating between these diagnostic groups (mild cognitive impairment or AD vs. controls) was examined with the aid of Receiver Operating Characteristic (ROC) curves. Additionally, we evaluated the benefit of the combination of tests on diagnostic accuracy. RESULTS Although they were accurate enough for the identification of Alzheimer's disease, neither test alone proved adequate for the correct separation of patients with mild cognitive impairment from healthy subjects. Combining these tests did not improve diagnostic accuracy, as compared to the Mini-Mental State Examination alone, in the identification of patients with mild cognitive impairment or Alzheimer's disease. CONCLUSIONS The present data do not warrant the combined use of the Mini-Mental State Examination, the Verbal Fluency Test and the Clock Drawing Test as a sufficient diagnostic schedule in screening for mild cognitive impairment. The present data do not support the notion that the combination of test scores is better that the use of Mini-Mental State Examination scores alone in the screening for Alzheimer's disease.
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Affiliation(s)
- Rodolfo B Ladeira
- Laboratory of Neuroscience-LIM 27, Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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