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Lombardi G, Berti V, Ginestroni A, Nacmias B, Sorbi S. The Association Between Positive Amyloid-PET and Cognitive Decline Is Not Always Supportive of Alzheimer's Disease: Suggestions from a Case Report. J Alzheimers Dis Rep 2024; 8:281-288. [PMID: 38405347 PMCID: PMC10894606 DOI: 10.3233/adr-230183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 01/17/2024] [Indexed: 02/27/2024] Open
Abstract
Amyloid-β deposition is the pathological hallmark of both cerebral amyloid angiopathy and Alzheimer's disease dementia, clinical conditions that can share cognitive decline and positive Amyloid-PET scan. A case is reported involving an 82-year-old Italian female who presented initially a memory deficit, later transient focal neurologic episodes, and finally two symptomatic lobar intracerebral hemorrhages. In light of these events, MRI and PET imaging findings, acquired before cerebral hemorrhages, are reconsidered and discussed, highlighting the utility of Amyloid-PET in supporting an in vivo diagnosis of cerebral amyloid angiopathy.
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Affiliation(s)
- Gemma Lombardi
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence, Italy
| | - Valentina Berti
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, Nuclear Medicine Unit, University of Florence, Florence, Italy
| | | | - Benedetta Nacmias
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence, Italy
| | - Sandro Sorbi
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence, Italy
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Hernández‐Lorenzo L, Gil‐Moreno MJ, Ortega‐Madueño I, Cárdenas MC, Diez‐Cirarda M, Delgado‐Álvarez A, Palacios‐Sarmiento M, Matias‐Guiu J, Corrochano S, Ayala JL, Matias‐Guiu JA. A data-driven approach to complement the A/T/(N) classification system using CSF biomarkers. CNS Neurosci Ther 2024; 30:e14382. [PMID: 37501389 PMCID: PMC10848077 DOI: 10.1111/cns.14382] [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: 04/26/2023] [Revised: 07/13/2023] [Accepted: 07/15/2023] [Indexed: 07/29/2023] Open
Abstract
AIMS The AT(N) classification system not only improved the biological characterization of Alzheimer's disease (AD) but also raised challenges for its clinical application. Unbiased, data-driven techniques such as clustering may help optimize it, rendering informative categories on biomarkers' values. METHODS We compared the diagnostic and prognostic abilities of CSF biomarkers clustering results against their AT(N) classification. We studied clinical (patients from our center) and research (Alzheimer's Disease Neuroimaging Initiative) cohorts. The studied CSF biomarkers included Aβ(1-42), Aβ(1-42)/Aβ(1-40) ratio, tTau, and pTau. RESULTS The optimal solution yielded three clusters in both cohorts, significantly different in diagnosis, AT(N) classification, values distribution, and survival. We defined these three CSF groups as (i) non-defined or unrelated to AD, (ii) early stages and/or more delayed risk of conversion to dementia, and (iii) more severe cognitive impairment subjects with faster progression to dementia. CONCLUSION We propose this data-driven three-group classification as a meaningful and straightforward approach to evaluating the risk of conversion to dementia, complementary to the AT(N) system classification.
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Affiliation(s)
- Laura Hernández‐Lorenzo
- Department of NeurologySan Carlos Research Institute (IdSSC), Hospital Clínico San CarlosMadridSpain
- Department of Computer Architecture and Automation, Computer Science FacultyComplutense University of MadridMadridSpain
| | - Maria José Gil‐Moreno
- Department of NeurologySan Carlos Research Institute (IdSSC), Hospital Clínico San CarlosMadridSpain
| | - Isabel Ortega‐Madueño
- Department of Clinical Analysis, Institute of Laboratory MedicineIdSSC, Hospital Clínico San CarlosMadridSpain
| | - Maria Cruz Cárdenas
- Department of Clinical Analysis, Institute of Laboratory MedicineIdSSC, Hospital Clínico San CarlosMadridSpain
| | - Maria Diez‐Cirarda
- Department of NeurologySan Carlos Research Institute (IdSSC), Hospital Clínico San CarlosMadridSpain
| | - Alfonso Delgado‐Álvarez
- Department of NeurologySan Carlos Research Institute (IdSSC), Hospital Clínico San CarlosMadridSpain
| | - Marta Palacios‐Sarmiento
- Department of NeurologySan Carlos Research Institute (IdSSC), Hospital Clínico San CarlosMadridSpain
| | - Jorge Matias‐Guiu
- Department of NeurologySan Carlos Research Institute (IdSSC), Hospital Clínico San CarlosMadridSpain
| | - Silvia Corrochano
- Department of NeurologySan Carlos Research Institute (IdSSC), Hospital Clínico San CarlosMadridSpain
| | - José L. Ayala
- Department of Computer Architecture and Automation, Computer Science FacultyComplutense University of MadridMadridSpain
| | - Jordi A. Matias‐Guiu
- Department of NeurologySan Carlos Research Institute (IdSSC), Hospital Clínico San CarlosMadridSpain
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Nerattini M, Rubino F, Arnone A, Polito C, Mazzeo S, Lombardi G, Puccini G, Nacmias B, De Cristofaro MT, Sorbi S, Pupi A, Sciagrà R, Bessi V, Berti V. Cerebral amyloid load determination in a clinical setting: interpretation of amyloid biomarker discordances aided by tau and neurodegeneration measurements. Neurol Sci 2021; 43:2469-2480. [PMID: 34739618 DOI: 10.1007/s10072-021-05704-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/26/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Alzheimer's disease (AD) diagnosis can be hindered by amyloid biomarkers discordances. OBJECTIVE We aim to interpret discordances between amyloid positron emission tomography (Amy-PET) and cerebrospinal fluid (CSF) (Aβ42 and Aβ42/40), using Amy-PET semiquantitative analysis, [18F]fluorodeoxyglucose (FDG)-PET pattern, and CSF assays. METHOD Thirty-six subjects with dementia or mild cognitive impairment, assessed by neuropsychological tests, structural and functional imaging, and CSF assays (Aβ42, Aβ42/40, p-tau, t-tau), were retrospectively examined. Amy-PET and FDG-PET scans were analyzed by visual assessment and voxel-based analysis. SUVR were calculated on Amy-PET scans. RESULTS Groups were defined basing on the agreement among CSF Aβ42 (A), CSF Aβ42/40 Ratio (R), and Amy-PET (P) dichotomic results ( ±). In discordant groups, CSF assays, Amy-PET semiquantification, and FDG-PET patterns supported the diagnosis suggested by any two agreeing amyloid biomarkers. In groups with discordant CSF Aβ42, the ratio always agrees with Amy-PET results, solving both false-negative and false-positive Aβ42 results, with Aβ42 levels close to the cut-off in A + R-P- subjects. The A + R + P- group presented high amyloid deposition in relevant areas, such as precuneus, posterior cingulate cortex (PCC) and dorsolateral frontal inferior cortex at semiquantitative analysis. CONCLUSION The amyloid discordant cases could be overcome by combining CSF Aβ42, CSF ratio, and Amy-PET results. The concordance of any 2 out of the 3 biomarkers seems to reveal the remaining one as a false result. A cut-off point review could avoid CSF Aβ42 false-negative results. The regional semiquantitative Amy-PET analysis in AD areas, such as precuneus and PCC, could increase the accuracy in AD diagnosis.
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Affiliation(s)
- Matilde Nerattini
- Nuclear Medicine Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Piero Palagi 1, 50139, Florence, Italy.
| | - Federica Rubino
- Nuclear Medicine Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Piero Palagi 1, 50139, Florence, Italy
| | - Annachiara Arnone
- Nuclear Medicine Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Piero Palagi 1, 50139, Florence, Italy
| | - Cristina Polito
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence (NEUROFARBA), Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Salvatore Mazzeo
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence (NEUROFARBA), Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Gemma Lombardi
- IRCCS Fondazione Don Carlo Gnocchi, Via Scandicci 269, 50143, Florence, Italy
| | - Giulia Puccini
- Department of Nuclear Medicine, Hospital of Prato, Via Suor Niccolina Infermiera, 20/22, 59100, Prato, Italy
| | - Benedetta Nacmias
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence (NEUROFARBA), Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Via Scandicci 269, 50143, Florence, Italy
| | - Maria Teresa De Cristofaro
- Nuclear Medicine Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Piero Palagi 1, 50139, Florence, Italy
| | - Sandro Sorbi
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence (NEUROFARBA), Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Via Scandicci 269, 50143, Florence, Italy
| | - Alberto Pupi
- Nuclear Medicine Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Piero Palagi 1, 50139, Florence, Italy
| | - Roberto Sciagrà
- Nuclear Medicine Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Piero Palagi 1, 50139, Florence, Italy
| | - Valentina Bessi
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence (NEUROFARBA), Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Valentina Berti
- Nuclear Medicine Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Piero Palagi 1, 50139, Florence, Italy
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