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Bao YW, Wang ZJ, Guo LL, Bai GJ, Feng Y, Zhao GD. Expression of regional brain amyloid-β deposition with [18F]Flutemetamol in Centiloid scale -a multi-site study. Neuroradiology 2024:10.1007/s00234-024-03364-5. [PMID: 38676749 DOI: 10.1007/s00234-024-03364-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/19/2024] [Indexed: 04/29/2024]
Abstract
PURPOSE The Centiloid project helps calibrate the quantitative amyloid-β (Aβ) load into a unified Centiloid (CL) scale that allows data comparison across multi-site. How the smaller regional amyloid converted into CL has not been attempted. We first aimed to express regional Aβ deposition in CL using [18F]Flutemetamol and evaluate regional Aβ deposition in CL with that in standardized uptake value ratio (SUVr). Second, we aimed to determine the presence or absence of focal Aβ deposition by measuring regional CL in equivocal cases showing negative global CL. METHODS Following the Centiloid project pipeline, Level-1 replication, Level-2 calibration, and quality control were completed to generate corresponding Centiloid conversion equations to convert SUVr into Centiloid at regional levels. In equivocal cases, the regional CL was compared with visual inspection to evaluate regional Aβ positivity. RESULTS 14 out of 16 regional conversions from [18F]Flutemetamol SUVr to Centiloid successfully passed the quality control, showing good reliability and relative variance, especially precuneus/posterior cingulate and prefrontal regions with good stability for Centiloid scaling. The absence of focal Aβ deposition could be detected by measuring regional CL, showing a high agreement rate with visual inspection. The regional Aβ positivity in the bilateral anterior cingulate cortex was most prevalent in equivocal cases. CONCLUSION The expression of regional brain Aβ deposition in CL with [18F]Flutemetamol has been attempted in this study. Equivocal cases had focal Aβ deposition that can be detected by measuring regional CL.
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Affiliation(s)
- Yi-Wen Bao
- Department of Medical Imaging Center, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, 1 Huanghe West Road, Huaiyin District, 223300, Huai'an, Jiangsu, China.
| | - Zuo-Jun Wang
- Department of Diagnostic Radiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Li-Li Guo
- Department of Medical Imaging Center, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, 1 Huanghe West Road, Huaiyin District, 223300, Huai'an, Jiangsu, China
| | - Gen-Ji Bai
- Department of Medical Imaging Center, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, 1 Huanghe West Road, Huaiyin District, 223300, Huai'an, Jiangsu, China
| | - Yun Feng
- Department of Medical Imaging Center, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, 1 Huanghe West Road, Huaiyin District, 223300, Huai'an, Jiangsu, China
| | - Guo-Dong Zhao
- Department of General Surgery, Lianshui County People's Hospital, 223400, Huai'an, Jiang Su, China
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Cotta Ramusino M, Massa F, Festari C, Gandolfo F, Nicolosi V, Orini S, Nobili F, Frisoni GB, Morbelli S, Garibotto V. Diagnostic performance of molecular imaging methods in predicting the progression from mild cognitive impairment to dementia: an updated systematic review. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06631-y. [PMID: 38355740 DOI: 10.1007/s00259-024-06631-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/27/2024] [Indexed: 02/16/2024]
Abstract
PURPOSE Epidemiological and logistical reasons are slowing the clinical validation of the molecular imaging biomarkers in the initial stages of neurocognitive disorders. We provide an updated systematic review of the recent advances (2017-2022), highlighting methodological shortcomings. METHODS Studies reporting the diagnostic accuracy values of the molecular imaging techniques (i.e., amyloid-, tau-, [18F]FDG-PETs, DaT-SPECT, and cardiac [123I]-MIBG scintigraphy) in predicting progression from mild cognitive impairment (MCI) to dementia were selected according to the Preferred Reporting Items for a Systematic Review and Meta-Analysis (PRISMA) method and evaluated with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Main eligibility criteria were as follows: (1) ≥ 50 subjects with MCI, (2) follow-up ≥ 3 years, (3) gold standard: progression to dementia or diagnosis on pathology, and (4) measures of prospective accuracy. RESULTS Sensitivity (SE) and specificity (SP) in predicting progression to dementia, mainly to Alzheimer's dementia were 43-100% and 63-94% for [18F]FDG-PET and 64-94% and 48-93% for amyloid-PET. Longitudinal studies were lacking for less common disorders (Dementia with Lewy bodies-DLB and Frontotemporal lobe degeneration-FTLD) and for tau-PET, DaT-SPECT, and [123I]-MIBG scintigraphy. Therefore, the accuracy values from cross-sectional studies in a smaller sample of subjects (n > 20, also including mild dementia stage) were chosen as surrogate outcomes. DaT-SPECT showed 47-100% SE and 71-100% SP in differentiating Lewy body disease (LBD) from non-LBD conditions; tau-PET: 88% SE and 100% SP in differentiating DLB from Posterior Cortical Atrophy. [123I]-MIBG scintigraphy differentiated LBD from non-LBD conditions with 47-100% SE and 71-100% SP. CONCLUSION Molecular imaging has a moderate-to-good accuracy in predicting the progression of MCI to Alzheimer's dementia. Longitudinal studies are sparse in non-AD conditions, requiring additional efforts in these settings.
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Affiliation(s)
- Matteo Cotta Ramusino
- Unit of Behavior Neurology and Dementia Research Center, IRCCS Mondino Foundation, via Mondino 2, 27100, Pavia, Italy.
| | - Federico Massa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cristina Festari
- Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Brescia, Italy
| | - Federica Gandolfo
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genoa, Italy
| | - Valentina Nicolosi
- UOC Neurologia Ospedale Magalini Di Villafranca Di Verona (VR) ULSS 9, Verona, Italy
| | - Stefania Orini
- Alzheimer's Unit-Memory Clinic, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Flavio Nobili
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giovanni B Frisoni
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
- Geneva Memory Center, Department of Rehabilitation and Geriatrics, Geneva University and University Hospitals, Geneva, Switzerland
| | - Silvia Morbelli
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Valentina Garibotto
- Division of Nuclear Medicine and Molecular Imaging, Diagnostic Department, University Hospitals of Geneva, Geneva, Switzerland
- NIMTLab, Department of Radiology and Medical Informatics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- CIBM Center for Biomedical Imaging, Geneva, Switzerland
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Høilund-Carlsen PF, Alavi A, Barrio JR, Castellani RJ, Costa T, Herrup K, Kepp KP, Neve RL, Perry G, Revheim ME, Robakis NK, Sensi SL, Vissel B. Revision of Alzheimer's diagnostic criteria or relocation of the Potemkin village. Ageing Res Rev 2024; 93:102173. [PMID: 38104639 DOI: 10.1016/j.arr.2023.102173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/13/2023] [Indexed: 12/19/2023]
Abstract
The recently announced revision of the Alzheimer's disease (AD) diagnostic ATN classification adds to an already existing disregard for clinical assessment the rejection of image-based in vivo assessment of the brain's condition. The revision suggests that the diagnosis of AD should be based solely on the presence of cerebral amyloid-beta and tau, indicated by the "A" and "T". The "N", which stands for neurodegeneration - detected by imaging - should no longer be given importance, except that A+ ± T + = AD with amyloid PET being the main method for demonstrating A+ . We believe this is an artificial and misleading suggestion. It is artificial because it relies on biomarkers whose significance remains obscure and where the detection of "A" is based on a never-validated PET method using a tracer that marks much more than amyloid-beta. It is misleading because many patients without dementia will be falsely classified as having AD, but nonetheless candidates for passive immunotherapy, which may be more harmful than beneficial, and sometimes fatal.
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Affiliation(s)
- Poul F Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Jorge R Barrio
- Department of Molecular and Medical Pharmacology, David Geffen UCLA School of Medicine, Los Angeles, CA, USA
| | - Rudolph J Castellani
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Tommaso Costa
- GCS-fMRI, Koelliker Hospital and Department of Psychology, University of Turin, Turin, Italy; FOCUS Lab, Department of Psychology, University of Turin, Turin, Italy
| | - Karl Herrup
- Department of Neurobiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kasper P Kepp
- Section of Biophysical and Biomedicinal Chemistry, DTU Chemistry, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Rachael L Neve
- Gene Delivery Technology Core, Massachusetts General Hospital, Boston, MA, USA
| | - George Perry
- Department of Neuroscience, Developmental and Regenerative Biology, University of Texas at San Antonio, San Antonio, TX, USA
| | - Mona-Elisabeth Revheim
- The Intervention Centre, Division of Technology and Innovation, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Nikolaos K Robakis
- Center for Molecular Biology and Genetics of Neurodegeneration, Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai Medical Center, New York, NY, USA
| | - Stefano L Sensi
- Department of Neurosciences, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy; CAST-Center for Advanced Studies and Technology, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy; ITAB-Institute of Advanced Biomedical Technology, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Bryce Vissel
- School of Clinical Medicine, UNSW Medicine & Health, St Vincent's Healthcare Clinical Campus Faculty of Medicine and Health, UNSW, Sydney, Australia; St Vincent's Hospital Centre for Applied Medical Research, St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
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Zilioli A, Misirocchi F, Pancaldi B, Mutti C, Ganazzoli C, Morelli N, Pellegrini FF, Messa G, Scarlattei M, Mohanty R, Ruffini L, Westman E, Spallazzi M. Predicting amyloid-PET status in a memory clinic: The role of the novel antero-posterior index and visual rating scales. J Neurol Sci 2023; 455:122806. [PMID: 38006829 DOI: 10.1016/j.jns.2023.122806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/27/2023] [Accepted: 11/16/2023] [Indexed: 11/27/2023]
Abstract
INTRODUCTION Visual rating scales are increasingly utilized in clinical practice to assess atrophy in crucial brain regions among patients with cognitive disorders. However, their capacity to predict Alzheimer's disease (AD)-related pathology remains unexplored, particularly within a heterogeneous memory clinic population. This study aims to assess the accuracy of a novel visual rating assessment, the antero-posterior index (API) scale, in predicting amyloid-PET status. Furthermore, the study seeks to determine the optimal cohort-based cutoffs for the medial temporal atrophy (MTA) and parietal atrophy (PA) scales and to integrate the main visual rating scores into a predictive model. METHODS We conducted a retrospective analysis of brain MRI and high-resolution TC scans from 153 patients with cognitive disorders who had undergone amyloid-PET assessments due to suspected AD pathology in a real-world memory clinic setting. RESULTS The API scale (cutoff ≥1) exhibited the highest accuracy (AUC = 0.721) among the visual rating scales. The combination of the cohort-based MTA and PA threshold with the API yielded favorable accuracy (AUC = 0.787). Analyzing a cohort of MCI/Mild dementia patients below 75 years of age, the API scale and the predictive model improved their accuracy (AUC = 0.741 and 0.813, respectively), achieving excellent results in the early-onset population (AUC = 0.857 and 0.949, respectively). CONCLUSION Our study emphasizes the significance of visual rating scales in predicting amyloid-PET positivity within a real-world memory clinic. Implementing the novel API scale, alongside our cohort-based MTA and PA thresholds, has the potential to substantially enhance diagnostic accuracy.
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Affiliation(s)
- Alessandro Zilioli
- Department of Medicine and Surgery, Unit of Neurology, University of Parma, Parma, Italy
| | - Francesco Misirocchi
- Department of Medicine and Surgery, Unit of Neurology, University of Parma, Parma, Italy.
| | - Beatrice Pancaldi
- Department of Medicine and Surgery, Unit of Neurology, University of Parma, Parma, Italy
| | - Carlotta Mutti
- Department of Medicine and Surgery, Unit of Neurology, University-Hospital of Parma, Parma, Italy; Sleep Disorders Center, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Nicola Morelli
- Department of Neurology, G. da Saliceto Hospital, Piacenza, Italy
| | | | - Giovanni Messa
- Center for Cognitive Disorders, AUSL Parma, Parma, Italy
| | - Maura Scarlattei
- Nuclear Medicine Unit, University Hospital of Parma, Parma, Italy
| | - Rosaleena Mohanty
- Division of Clinical Geriatrics; Center for Alzheimer Research; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Blickagången 16 (NEO building, floor 7th), 14152, Huddinge, Stockholm, Sweden
| | - Livia Ruffini
- Nuclear Medicine Unit, University Hospital of Parma, Parma, Italy
| | - Eric Westman
- Division of Clinical Geriatrics; Center for Alzheimer Research; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Blickagången 16 (NEO building, floor 7th), 14152, Huddinge, Stockholm, Sweden; Department of Neuroimaging, Center for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Marco Spallazzi
- Department of Medicine and Surgery, Unit of Neurology, University-Hospital of Parma, Parma, Italy
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van Maurik IS, Bakker ED, van Unnik AAJM, Broulikova HM, Zwan MD, van de Giessen E, Berkhof J, Bouwman FH, Bosmans JE, van der Flier WM. How healthy participants value additional diagnostic testing with amyloid-PET in patients diagnosed with mild cognitive impairment - a bidding game experiment. Alzheimers Res Ther 2023; 15:208. [PMID: 38017549 PMCID: PMC10683285 DOI: 10.1186/s13195-023-01346-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 10/25/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND To estimate the perceived value of additional testing with amyloid-PET in Euros in healthy participants acting as analogue patients with mild cognitive impairment (MCI). METHODS One thousand four hundred thirty-one healthy participants acting as analogue MCI patients (mean age 65 ± 8, 929 (75%) female) were recruited via the Dutch Brain Research Registry. Participants were asked to identify with a presented case (video vignette) of an MCI patient and asked whether they would prefer additional diagnostic testing with amyloid PET in this situation. If yes, respondents were asked how much they would be willing to pay for additional diagnostic testing. Monetary value was elicited via a bidding game in which participants were randomized over three conditions: (A) additional testing results in better patient management, (B) Same as condition A and a delay in institutionalization of 3 months, and (C) same as A and a delay in institutionalization of 6 months. Participants who were not willing to take a test were compared with participants who were willing to take a test using logit models. The highest monetary value per condition was analyzed using random-parameter mixed models. RESULTS The vast majority of participants acting as analogue MCI patients (87% (n = 1238)) preferred additional testing with amyloid PET. Participants who were not interested were more often female (OR = 1.61 95% CI [1.09-2.40]) and expressed fewer worries to get AD (OR = 0.64 [0.47-0.87]). The median "a priori" (i.e., before randomization) monetary value of additional diagnostic testing was €1500 (IQR 500-1500). If an additional amyloid PET resulted in better patient management (not further specified; condition A), participants were willing to pay a median price of €2000 (IQR = 1000-3500). Participants were willing to pay significantly more than condition A (better patient management) if amyloid-PET testing additionally resulted in a delay in institutionalization of 3 months (€530 [255-805] on top of €2000, condition B) or 6 months (€596 [187-1005] on top of €2000, condition C). CONCLUSIONS Members of the general population acting as MCI patients are willing to pay a substantial amount of money for amyloid-PET and this increases when diagnostic testing leads to better patient management and the prospect to live longer at home.
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Affiliation(s)
- I S van Maurik
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, De Boelelaan 1118, Amsterdam, The Netherlands.
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands.
- Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
- Amsterdam Public Health, Methodology, Amsterdam, The Netherlands.
| | - E D Bakker
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, De Boelelaan 1118, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - A A J M van Unnik
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, De Boelelaan 1118, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - H M Broulikova
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - M D Zwan
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, De Boelelaan 1118, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - E van de Giessen
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, De Boelelaan 1118, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, the Netherlands
| | - J Berkhof
- Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
| | - F H Bouwman
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, De Boelelaan 1118, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - J E Bosmans
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - W M van der Flier
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, De Boelelaan 1118, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
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Guillén N, Contador J, Buongiorno M, Álvarez I, Culell N, Alcolea D, Lleó A, Fortea J, Piñol-Ripoll G, Carnes-Vendrell A, Lourdes Ispierto M, Vilas D, Puig-Pijoan A, Fernández-Lebrero A, Balasa M, Sánchez-Valle R, Lladó A. Agreement of cerebrospinal fluid biomarkers and amyloid-PET in a multicenter study. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01701-y. [PMID: 37898567 DOI: 10.1007/s00406-023-01701-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 10/02/2023] [Indexed: 10/30/2023]
Abstract
Core Alzheimer's disease (AD) cerebrospinal fluid (CSF) biomarkers have shown incomplete agreement with amyloid-positron emission tomography (PET). Our goal was to analyze the agreement between AD CSF biomarkers and amyloid-PET in a multicenter study. Retrospective multicenter study (5 centers). Participants who underwent both CSF biomarkers and amyloid-PET scan within 18 months were included. Clinical diagnoses were made according to latest diagnostic criteria by the attending clinicians. CSF Amyloid Beta1-42 (Aβ1-42, A), phosphorliated tau 181 (pTau181, T) and total tau (tTau, N) biomarkers were considered normal (-) or abnormal ( +) according to cutoffs of each center. Amyloid-PET was visually classified as positive/negative. Agreement between CSF biomarkers and amyloid-PET was analyzed by overall percent agreement (OPA). 236 participants were included (mean age 67.9 years (SD 9.1), MMSE score 24.5 (SD 4.1)). Diagnoses were mild cognitive impairment or dementia due to AD (49%), Lewy body dementia (22%), frontotemporal dementia (10%) and others (19%). Mean time between tests was 5.1 months (SD 4.1). OPA between single CSF biomarkers and amyloid-PET was 74% for Aβ1-42, 75% for pTau181, 73% for tTau. The use of biomarker ratios improved OPA: 87% for Aβ1-42/Aβ1-40 (n = 155), 88% for pTau181/Aβ1-42 (n = 94) and 82% for tTau/Aβ1-42 (n = 160). A + T + N + cases showed the highest agreement between CSF biomarkers and amyloid-PET (96%), followed by A-T-N- cases (89%). Aβ1-42/Aβ1-40 was a better marker of cerebral amyloid deposition, as identified by amyloid tracers, than Aβ1-42 alone. Combined biomarkers in CSF predicted amyloid-PET result better than single biomarkers.
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Affiliation(s)
- Núria Guillén
- Alzheimer's Disease and Other Cognitive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Carrer Villarroel, 170, 08036, Barcelona, Spain
| | - José Contador
- Alzheimer's Disease and Other Cognitive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Carrer Villarroel, 170, 08036, Barcelona, Spain
| | - Mariateresa Buongiorno
- Memory Disorders Unit, Department of Neurology, Hospital Universitari Mutua de Terrassa, Terrassa, Spain
- Fundació Docència i Recerca Mútua Terrassa, Terrassa, Spain
| | - Ignacio Álvarez
- Memory Disorders Unit, Department of Neurology, Hospital Universitari Mutua de Terrassa, Terrassa, Spain
- Fundació Docència i Recerca Mútua Terrassa, Terrassa, Spain
| | - Natalia Culell
- Memory Disorders Unit, Department of Neurology, Hospital Universitari Mutua de Terrassa, Terrassa, Spain
- Fundació Docència i Recerca Mútua Terrassa, Terrassa, Spain
| | - Daniel Alcolea
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau-Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas. CIBERNED, Madrid, Spain
| | - Alberto Lleó
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau-Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas. CIBERNED, Madrid, Spain
| | - Juan Fortea
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau-Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas. CIBERNED, Madrid, Spain
| | - Gerard Piñol-Ripoll
- Clinical Neuroscience Research, Unitat Trastorns Cognitius, IRBLleida, Santa Maria University Hospital, Lleida, Spain
| | - Anna Carnes-Vendrell
- Clinical Neuroscience Research, Unitat Trastorns Cognitius, IRBLleida, Santa Maria University Hospital, Lleida, Spain
| | - María Lourdes Ispierto
- Neurodegenerative Diseases Unit, Neurology Service and Neurosciences Department, University Hospital Germans Trias i Pujol (HUGTP), Badalona, Spain
| | - Dolores Vilas
- Neurodegenerative Diseases Unit, Neurology Service and Neurosciences Department, University Hospital Germans Trias i Pujol (HUGTP), Badalona, Spain
| | - Albert Puig-Pijoan
- Cognitive Decline and Movement Disorders Unit, Neurology Department, Hospital del Mar, Barcelona, Spain
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Aida Fernández-Lebrero
- Cognitive Decline and Movement Disorders Unit, Neurology Department, Hospital del Mar, Barcelona, Spain
| | - Mircea Balasa
- Alzheimer's Disease and Other Cognitive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Carrer Villarroel, 170, 08036, Barcelona, Spain
| | - Raquel Sánchez-Valle
- Alzheimer's Disease and Other Cognitive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Carrer Villarroel, 170, 08036, Barcelona, Spain
- Institute of Neurosciences, Department of Medicine, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Albert Lladó
- Alzheimer's Disease and Other Cognitive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Carrer Villarroel, 170, 08036, Barcelona, Spain.
- Institute of Neurosciences, Department of Medicine, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
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Ward J, Ly M, Raji CA. Brain PET Imaging: Frontotemporal Dementia. PET Clin 2023; 18:123-133. [PMID: 36442960 PMCID: PMC9884902 DOI: 10.1016/j.cpet.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Brain PET adds value in diagnosing neurodegenerative disorders, especially frontotemporal dementia (FTD) due to its syndromic presentation that overlaps with a variety of other neurodegenerative and psychiatric disorders. 18F-FDG-PET has improved sensitivity and specificity compared with structural MR imaging, with optimal diagnostic results achieved when both techniques are utilized. PET demonstrates superior sensitivity compared with SPECT for FTD diagnosis that is primarily a supplement to other imaging and clinical evaluations. Tau-PET and amyloid-PET primary use in FTD diagnosis is differentiation from Alzheimer disease, although these methods are limited mainly to research settings.
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Affiliation(s)
- Joshua Ward
- Division of Neuroradiology, Mallinckrodt Institute of Radiology, Washington University in Saint. Louis, Saint Louis, MO 63130, USA
| | - Maria Ly
- Division of Neuroradiology, Mallinckrodt Institute of Radiology, Washington University in Saint. Louis, Saint Louis, MO 63130, USA
| | - Cyrus A. Raji
- Division of Neuroradiology, Mallinckrodt Institute of Radiology, Washington University in Saint. Louis, Saint Louis, MO 63130, USA,Department of Neurology, Washington University in St. Louis, 4525 Scott Avenue, St. Louis, MO 63110, USA,Corresponding author. Division of Neuroradiology, Mallinckrodt Institute of Radiology, Washington University in Saint. Louis, Saint Louis, MO 63130.
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Luckett ES, Schaeverbeke J, De Meyer S, Adamczuk K, Van Laere K, Dupont P, Vandenberghe R. Longitudinal changes in 18F-Flutemetamol amyloid load in cognitively intact APOE4 carriers versus noncarriers: Methodological considerations. Neuroimage Clin 2023; 37:103321. [PMID: 36621019 PMCID: PMC9850036 DOI: 10.1016/j.nicl.2023.103321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 12/12/2022] [Accepted: 01/04/2023] [Indexed: 01/07/2023]
Abstract
PURPOSE Measuring longitudinal changes in amyloid load in the asymptomatic stage of Alzheimer's disease is of high relevance for clinical research and progress towards more efficacious, timely treatments. Apolipoprotein E ε4 (APOE4) has a well-established effect on the rate of amyloid accumulation. Here we investigated which region of interest and which reference region perform best at detecting the effect of APOE4 on longitudinal amyloid load in individuals participating in the Flemish Prevent Alzheimer's Disease Cohort KU Leuven (F-PACK). METHODS Ninety cognitively intact F-PACK participants (baseline age: 68 (52-80) years, 46 males, 42 APOE4 carriers) received structural MRI and 18F-Flutemetamol PET scans at baseline and follow-up (6.2 (3.4-10.9) year interval). Standardised uptake value ratios (SUVRs) and Centiloids (CLs) were calculated in a composite cortical volume of interest (SUVRcomp/CL) and in the precuneus (SUVRprec), and amyloid rate of change derived: (follow-up amyloid load - baseline amyloid load) / time interval (years). Four reference regions were used to derive amyloid load: whole cerebellum, cerebellar grey matter, eroded subcortical white matter, and pons. RESULTS When using whole cerebellum or cerebellar grey matter as reference region, APOE4 carriers had a significantly higher SUVRcomp amyloid rate of change than non-carriers (pcorr = 0.004, t = 3.40 (CI 0.005-0.018); pcorr = 0.036, t = 2.66 (CI 0.003-0.018), respectively). Significance was not observed for eroded subcortical white matter or pons (pcorr = 0.144, t = 2.13 (CI 0.0003-0.008); pcorr = 0.116, t = 2.22 (CI 0.005-0.010), respectively). When using CLs as the amyloid measurement, and whole cerebellum, APOE4 carriers had a higher amyloid rate of change than non-carriers (pcorr = 0.012, t = 3.05 (CI 0.499-2.359)). Significance was not observed for the other reference regions. No significance was observed with any of the reference regions and amyloid rate of change in the precuneus (SUVRprec). CONCLUSION In this cognitively intact cohort, a composite neocortical volume of interest together with whole cerebellum or cerebellar grey matter as reference region are the methods of choice for detecting APOE4-dependent differences in amyloid rate of change.
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Affiliation(s)
- Emma S Luckett
- Laboratory for Cognitive Neurology, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium; Alzheimer Research Centre KU Leuven, Leuven Brain Institute, Leuven, Belgium
| | - Jolien Schaeverbeke
- Laboratory for Cognitive Neurology, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium; Alzheimer Research Centre KU Leuven, Leuven Brain Institute, Leuven, Belgium
| | - Steffi De Meyer
- Laboratory for Cognitive Neurology, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium; Alzheimer Research Centre KU Leuven, Leuven Brain Institute, Leuven, Belgium; Laboratory for Molecular Neurobiomarker Research, KU Leuven, Leuven, Belgium
| | | | - Koen Van Laere
- Division of Nuclear Medicine, UZ Leuven, Leuven, Belgium; Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Patrick Dupont
- Laboratory for Cognitive Neurology, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium; Alzheimer Research Centre KU Leuven, Leuven Brain Institute, Leuven, Belgium
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium; Alzheimer Research Centre KU Leuven, Leuven Brain Institute, Leuven, Belgium; Neurology Department, University Hospitals Leuven, Leuven, Belgium.
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Biel D, Brendel M, Rubinski A, Buerger K, Janowitz D, Dichgans M, Franzmeier N. Tau-PET and in vivo Braak-staging as prognostic markers of future cognitive decline in cognitively normal to demented individuals. Alzheimers Res Ther 2021; 13:137. [PMID: 34384484 PMCID: PMC8361801 DOI: 10.1186/s13195-021-00880-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/21/2021] [Indexed: 11/20/2022]
Abstract
Background To systematically examine the clinical utility of tau-PET and Braak-staging as prognostic markers of future cognitive decline in older adults with and without cognitive impairment. Methods In this longitudinal study, we included 396 cognitively normal to dementia subjects with 18F-Florbetapir/18F-Florbetaben-amyloid-PET, 18F-Flortaucipir-tau-PET and ~ 2-year cognitive follow-up. Annual change rates in global cognition (i.e., MMSE, ADAS13) and episodic memory were calculated via linear-mixed models. We determined global amyloid-PET (Centiloid) plus global and Braak-stage-specific tau-PET SUVRs, which were stratified as positive(+)/negative(−) at pre-established cut-offs, classifying subjects as Braak0/BraakI+/BraakI–IV+/BraakI–VI+/Braakatypical+. In bootstrapped linear regression, we assessed the predictive accuracy of global tau-PET SUVRs vs. Centiloid on subsequent cognitive decline. To test for independent tau vs. amyloid effects, analyses were further controlled for the contrary PET-tracer. Using ANCOVAs, we tested whether more advanced Braak-stage predicted accelerated future cognitive decline. All models were controlled for age, sex, education, diagnosis, and baseline cognition. Lastly, we determined Braak-stage-specific conversion risk to mild cognitive impairment (MCI) or dementia. Results Baseline global tau-PET SUVRs explained more variance (partial R2) in future cognitive decline than Centiloid across all cognitive tests (Cohen’s d ~ 2, all tests p < 0.001) and diagnostic groups. Associations between tau-PET and cognitive decline remained consistent when controlling for Centiloid, while associations between amyloid-PET and cognitive decline were non-significant when controlling for tau-PET. More advanced Braak-stage was associated with gradually worsening future cognitive decline, independent of Centiloid or diagnostic group (p < 0.001), and elevated conversion risk to MCI/dementia. Conclusion Tau-PET and Braak-staging are highly predictive markers of future cognitive decline and may be promising single-modality estimates for prognostication of patient-specific progression risk in clinical settings. Supplementary Information The online version contains supplementary material available at 10.1186/s13195-021-00880-x.
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Affiliation(s)
- Davina Biel
- Institute, for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, 81377, Munich, Germany
| | - Matthias Brendel
- Department of Nuclear Medicine, University Hospital, LMU Munich, 80336, Munich, Germany
| | - Anna Rubinski
- Institute, for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, 81377, Munich, Germany
| | - Katharina Buerger
- Institute, for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, 81377, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE, Munich), Munich, Germany
| | - Daniel Janowitz
- Institute, for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, 81377, Munich, Germany
| | - Martin Dichgans
- Institute, for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, 81377, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE, Munich), Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Nicolai Franzmeier
- Institute, for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, 81377, Munich, Germany.
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Cotta Ramusino M, Perini G, Altomare D, Barbarino P, Weidner W, Salvini Porro G, Barkhof F, Rabinovici GD, van der Flier WM, Frisoni GB, Garibotto V, Teipel S, Boccardi M. Outcomes of clinical utility in amyloid-PET studies: state of art and future perspectives. Eur J Nucl Med Mol Imaging 2021; 48:2157-68. [PMID: 33594474 DOI: 10.1007/s00259-020-05187-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/28/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE To review how outcomes of clinical utility are operationalized in current amyloid-PET validation studies, to prepare for formal assessment of clinical utility of amyloid-PET-based diagnosis. METHODS Systematic review of amyloid-PET research studies published up to April 2020 that included outcomes of clinical utility. We extracted and analyzed (a) outcome categories, (b) their definition, and (c) their methods of assessment. RESULTS Thirty-two studies were eligible. (a) Outcome categories were clinician-centered (found in 25/32 studies, 78%), patient-/caregiver-centered (in 9/32 studies, 28%), and health economics-centered (5/32, 16%). (b) Definition: Outcomes were mainly defined by clinical researchers; only the ABIDE study expressly included stakeholders in group discussions. Clinician-centered outcomes mainly consisted of incremental diagnostic value (25/32, 78%) and change in patient management (17/32, 53%); patient-/caregiver-centered outcomes considered distress after amyloid-pet-based diagnosis disclosure (8/32, 25%), including quantified burden of procedure for patients' outcomes (n = 8) (1/8, 12.5%), impact of disclosure of results (6/8, 75%), and psychological implications of biomarker-based diagnosis (75%); and health economics outcomes focused on costs to achieve a high-confidence etiological diagnosis (5/32, 16%) and impact on quality of life (1/32, 3%). (c) Assessment: all outcome categories were operationalized inconsistently across studies, employing 26 different tools without formal rationale for selection. CONCLUSION Current studies validating amyloid-PET already assessed outcomes for clinical utility, although non-clinician-based outcomes were inconsistent. A wider participation of stakeholders may help produce a more thorough and systematic definition and assessment of outcomes of clinical utility and help collect evidence informing decisions on reimbursement of amyloid-PET.
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11
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Rubinski A, Tosun D, Franzmeier N, Neitzel J, Frontzkowski L, Weiner M, Ewers M. Lower cerebral perfusion is associated with tau-PET in the entorhinal cortex across the Alzheimer's continuum. Neurobiol Aging 2021; 102:111-8. [PMID: 33765424 DOI: 10.1016/j.neurobiolaging.2021.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 12/28/2022]
Abstract
Alzheimer's disease (AD) is associated with reduced temporo-parietal cerebral blood flow (CBF). However, a substantial variability in CBF across the clinical spectrum of AD has been reported, possibly due to differences in primary AD pathologies. Here, we assessed CBF (ASL-MRI), tau (AV1451-PET) and amyloid (AV45/FBB-PET) in 156 subjects across the AD continuum. Using mixed-effect regression analyses, we assessed the local associations between amyloid-PET, tau-PET and CBF in a hypothesis-driven way focusing on each pathology's predilection areas. The contribution of Apolipoprotein E (APOE) genotype, and MRI markers of small vessel disease (SVD) to alterations in CBF were assessed as well. Tau-PET was associated with lower CBF in the entorhinal cortex, independent of Aβ. Amyloid-PET was associated with lower CBF in temporo-parietal regions. No associations between MRI markers of SVD and CBF were observed. These results provide evidence that in addition to Aβ, pathologic tau is a major correlate of CBF in early Braak stages, independent of Aβ, APOE genotype and SVD markers.
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12
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Rubinski A, Franzmeier N, Neitzel J, Ewers M. FDG-PET hypermetabolism is associated with higher tau-PET in mild cognitive impairment at low amyloid-PET levels. Alzheimers Res Ther 2020; 12:133. [PMID: 33076977 PMCID: PMC7574434 DOI: 10.1186/s13195-020-00702-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 10/05/2020] [Indexed: 12/04/2022]
Abstract
Background FDG-PET hypermetabolism can be observed in mild cognitive impairment (MCI), but the link to primary pathologies of Alzheimer’s diseases (AD) including amyloid and tau is unclear. Methods Using voxel-based regression, we assessed local interactions between amyloid- and tau-PET on spatially matched FDG-PET in 72 MCI patients. Control groups included cerebrospinal fluid biomarker characterized cognitively normal (CN, n = 70) and AD dementia subjects (n = 95). Results In MCI, significant amyloid-PET by tau-PET interactions were found in frontal, lateral temporal, and posterior parietal regions, where higher local tau-PET was associated with higher spatially corresponding FDG-PET at low levels of local amyloid-PET. FDG-PET in brain regions with a significant local amyloid- by tau-PET interaction was higher compared to that in CN and AD dementia and associated with lower episodic memory. Conclusion Higher tau-PET in the presence of low amyloid-PET is associated with abnormally increased glucose metabolism that is accompanied by episodic memory impairment.
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Affiliation(s)
- Anna Rubinski
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Feodor-Lynen-Straße 17, 81377, Munich, Germany
| | - Nicolai Franzmeier
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Feodor-Lynen-Straße 17, 81377, Munich, Germany
| | - Julia Neitzel
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Feodor-Lynen-Straße 17, 81377, Munich, Germany
| | - Michael Ewers
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Feodor-Lynen-Straße 17, 81377, Munich, Germany. .,German Center for Neurodegenerative Diseases, Munich, Germany.
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13
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Franke TN, Irwin C, Bayer TA, Brenner W, Beindorff N, Bouter C, Bouter Y. In vivo Imaging With 18F-FDG- and 18F-Florbetaben-PET/MRI Detects Pathological Changes in the Brain of the Commonly Used 5XFAD Mouse Model of Alzheimer's Disease. Front Med (Lausanne) 2020; 7:529. [PMID: 33043029 PMCID: PMC7522218 DOI: 10.3389/fmed.2020.00529] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/27/2020] [Indexed: 12/14/2022] Open
Abstract
Imaging biomarkers of Alzheimer's disease (AD) that are able to detect molecular changes in vivo and transgenic animal models mimicking AD pathologies are essential for the evaluation of new therapeutic strategies. Positron-emission tomography (PET) using either 18F-Fluorodeoxyglucose (18F-FDG) or amyloid-tracers is a well-established, non-invasive tool in the clinical diagnostics of AD assessing two major pathological hallmarks. 18F-FDG-PET is able to detect early changes in cerebral glucose metabolism and amyloid-PET shows cerebral amyloid load. However, the suitability of 18F-FDG- and amyloid-PET in the widely used 5XFAD mouse model of AD is unclear as only a few studies on the use of PET biomarkers are available showing some conflicting results. The aim of this study was the evaluation of 18F-FDG-PET and amyloid-PET in 5XFAD mice in comparison to neurological deficits and neuropathological changes. Seven- and 12-month-old male 5XFAD mice showed a significant reduction in brain glucose metabolism in 18F-FDG-PET and amyloid-PET with 18F-Florbetaben demonstrated an increased cerebral amyloid deposition (n = 4-6 per group). Deficits in spatial reference memory were detected in 12-month-old 5XFAD mice in the Morris Water Maze (n = 10-12 per group). Furthermore, an increased plaque load and gliosis could be proven immunohistochemically in 5XFAD mice (n = 4-6 per group). PET biomarkers 18F-FDG and 18F-Florbetaben detected cerebral hypometabolism and increased plaque load even before the onset of severe memory deficits. Therefore, the 5XFAD mouse model of AD is well-suited for in vivo monitoring of AD pathologies and longitudinal testing of new therapeutic approaches.
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Affiliation(s)
- Timon N Franke
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen (UMG), Georg-August-University, Göttingen, Germany
| | - Caroline Irwin
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen (UMG), Georg-August-University, Göttingen, Germany
| | - Thomas A Bayer
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen (UMG), Georg-August-University, Göttingen, Germany
| | - Winfried Brenner
- Department of Nuclear Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Nicola Beindorff
- Berlin Experimental Radionuclide Imaging Center (BERIC), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Caroline Bouter
- Department of Nuclear Medicine, University Medical Center Göttingen (UMG), Georg-August-University, Göttingen, Germany
| | - Yvonne Bouter
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen (UMG), Georg-August-University, Göttingen, Germany
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14
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Tiepolt S, Rullmann M, Jochimsen TH, Gertz HJ, Schroeter ML, Patt M, Sabri O, Barthel H. Quantitative susceptibility mapping in β-Amyloid PET-stratified patients with dementia and healthy controls - A hybrid PET/MRI study. Eur J Radiol 2020; 131:109243. [PMID: 32916411 DOI: 10.1016/j.ejrad.2020.109243] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 07/23/2020] [Accepted: 08/11/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE Post-mortem and in-vivo MRI data suggest an accumulation of iron in the brain of Alzheimer's disease (AD) patients. The majority of studies in clinically diagnosed AD patients found an increase of iron-sensitive MRI signals in the putamen. As the clinical diagnosis shows only a moderate sensitivity, Aβ-PET was used to further stratify patients with the clinical diagnosis of AD. Aim of this exploratory study was to examine whether Aβ-positive (AD) and Aβ-negative (non-AD) patients differ in their regional magnetic susceptibility compared to healthy controls (HCs) and whether regional susceptibility values correlate with mini mental state examination (MMSE) scores or global Aβ-load. METHODS We retrospectively analyzed [11C]PiB PET/MRI data of 11 HCs, 16 AD and 10 non-AD patients. We used quantitative susceptibility mapping (QSM) as iron-sensitive MRI signal measured at the 3 T PET/MR scanner. Global cerebral Aβ-load was determined by composite [11C]PiB SUV ratios. RESULTS Compared to HCs, AD patients showed higher QSM values in putamen (0.049 ± 0.033 vs. 0.002 ± 0.031; p = 0.006), while non-AD patients showed lower QSM values in caudate nucleus (0.003 ± 0.027 vs. 0.051 ± 0.039; p = 0.006). There was a trend towards a significant correlation between putaminal QSM and MMSE values (ρ=-0.340, p = 0.053). In AD patients, global Aβ-load and putaminal QSM values were significantly correlated (ρ=-0.574, p = 0.020). CONCLUSIONS These data indicate that AD and non-AD patients may show different cerebral iron pathologies which might be detectable by QSM MRI, and might be linked to neurodegeneration. Overall, the data encourage further investigations in well-defined patient cohorts to clarify the value of QSM/magnetic susceptibility in the course of neurodegenerative diseases and its potential as diagnostic biomarker.
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Vogelgsang J, Kis B, Radenbach K, Wolff-Menzler C, Mavridou K, Timäus C, Gyßer S, Wiltfang J, Hessmann P. Nuclear medical imaging as part of dementia diagnostics in psychiatric day-care clinics and inpatient care settings. Aging Clin Exp Res 2020; 32:809-815. [PMID: 31286431 DOI: 10.1007/s40520-019-01257-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 06/24/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Current guidelines support the use of nuclear medical imaging (NMI) techniques for differential diagnostics of certain cases of dementia. AIMS We aimed at studying the association between using NMI and the accuracy of dementia diagnoses. Additionally, we evaluated the effect of conducting NMI on the duration of hospital treatment. METHODS This study was based on data collected according to §21 of the German hospital remuneration law, including relevant diagnostic and procedural codes for NMI in dementia patients. In total, more than 7.2 million cases treated in German psychiatric and somatic hospitals between 2015 and 2017 were included. Associations between the frequency of NMI and the accuracy of dementia diagnoses in terms of specific vs. unspecific diagnostic codes were analyzed using Fischer's exact test. RESULTS In total, 351,106 cases with a dementia diagnosis were encoded during the study period. NMI was performed in 1.03% or 0.15% of all patients with dementia in psychiatric or somatic clinics, respectively. In psychiatric clinics, the proportion of unspecific dementia diagnoses decreased from 20.86% in 2015 to 17.73% in 2017. NMI was mainly performed within psychiatric day-care settings. Interestingly, patients receiving NMI stayed shorter within day-care settings (8.1 ± 16.0 days) compared to inpatient settings (38.3 ± 44.7 days). CONCLUSIONS Nuclear medical imaging is often performed in psychiatric day-care settings. Further studies are warranted to understand the predictive diagnostic value of NMI in dementia diagnosis compared with clinical, CSF and structural imaging in different healthcare settings.
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Affiliation(s)
- Jonathan Vogelgsang
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, 37075, Goettingen, Germany.
| | - Bernhard Kis
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, 37075, Goettingen, Germany
| | - Katrin Radenbach
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, 37075, Goettingen, Germany
| | - Claus Wolff-Menzler
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, 37075, Goettingen, Germany
| | - Kiriaki Mavridou
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, 37075, Goettingen, Germany
| | - Charles Timäus
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, 37075, Goettingen, Germany
| | - Stephan Gyßer
- GSG Consulting GmbH, Senior Consultant Business Intelligence, Dortmund, 44319, Germany
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, 37075, Goettingen, Germany
- German Center for Neurodegenerative Diseases, Goettingen, 37075, Germany
- Medical Science Department, iBiMED, University of Aveiro, Aveiro, Portugal
| | - Philipp Hessmann
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, 37075, Goettingen, Germany
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Pérez-Grijalba V, Arbizu J, Romero J, Prieto E, Pesini P, Sarasa L, Guillen F, Monleón I, San-José I, Martínez-Lage P, Munuera J, Hernández I, Buendía M, Sotolongo-Grau O, Alegret M, Ruiz A, Tárraga L, Boada M, Sarasa M. Plasma Aβ42/40 ratio alone or combined with FDG-PET can accurately predict amyloid-PET positivity: a cross-sectional analysis from the AB255 Study. Alzheimers Res Ther 2019; 11:96. [PMID: 31787105 PMCID: PMC6886187 DOI: 10.1186/s13195-019-0549-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 10/22/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND To facilitate population screening and clinical trials of disease-modifying therapies for Alzheimer's disease, supportive biomarker information is necessary. This study was aimed to investigate the association of plasma amyloid-beta (Aβ) levels with the presence of pathological accumulation of Aβ in the brain measured by amyloid-PET. Both plasma Aβ42/40 ratio alone or combined with an FDG-PET-based biomarker of neurodegeneration were assessed as potential AD biomarkers. METHODS We included 39 cognitively normal subjects and 20 patients with mild cognitive impairment from the AB255 Study who had undergone PiB-PET scans. Total Aβ40 and Aβ42 levels in plasma (TP42/40) were quantified using ABtest kits. Subjects were dichotomized as Aβ-PET positive or negative, and the ability of TP42/40 to detect Aβ-PET positivity was assessed by logistic regression and receiver operating characteristic analyses. Combination of plasma Aβ biomarkers and FDG-PET was further assessed as an improvement for brain amyloidosis detection and diagnosis classification. RESULTS Eighteen (30.5%) subjects were Aβ-PET positive. TP42/40 ratio alone identified Aβ-PET status with an area under the curve (AUC) of 0.881 (95% confidence interval [CI] = 0.779-0.982). Discriminating performance of TP42/40 to detect Aβ-PET-positive subjects yielded sensitivity and specificity values at Youden's cutoff of 77.8% and 87.5%, respectively, with a positive predictive value of 0.732 and negative predictive value of 0.900. All these parameters improved after adjusting the model for significant covariates. Applying TP42/40 as the first screening tool in a sequential diagnostic work-up would reduce the number of Aβ-PET scans by 64%. Combination of both FDG-PET scores and plasma Aβ biomarkers was found to be the most accurate Aβ-PET predictor, with an AUC of 0.965 (95% CI = 0.913-0.100). CONCLUSIONS Plasma TP42/40 ratio showed a relevant and significant potential as a screening tool to identify brain Aβ positivity in preclinical and prodromal stages of Alzheimer's disease.
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Affiliation(s)
| | - Javier Arbizu
- Servicio de Medicina Nuclear, Clínica Universidad de Navarra, Pamplona, Spain
| | - Judith Romero
- Araclon Biotech S.L., Vía Hispanidad 21, 50009, Zaragoza, Spain
| | - Elena Prieto
- Servicio de Medicina Nuclear, Clínica Universidad de Navarra, Pamplona, Spain
| | - Pedro Pesini
- Araclon Biotech S.L., Vía Hispanidad 21, 50009, Zaragoza, Spain.
| | - Leticia Sarasa
- Araclon Biotech S.L., Vía Hispanidad 21, 50009, Zaragoza, Spain
| | - Fernando Guillen
- Servicio de Medicina Nuclear, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Itziar San-José
- Araclon Biotech S.L., Vía Hispanidad 21, 50009, Zaragoza, Spain
| | - Pablo Martínez-Lage
- Center for Research and Advanced Therapies and Memory Clinic, Fundación CITA-Alzheimer, San Sebastián, Spain
| | - Josep Munuera
- Institut de recerca Sant Joan de Déu, Hospital Infantil Sant Joan de Déu, Barcelona, Spain
| | - Isabel Hernández
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya-Barcelona, Barcelona, Spain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Mar Buendía
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya-Barcelona, Barcelona, Spain
| | - Oscar Sotolongo-Grau
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya-Barcelona, Barcelona, Spain
| | - Montserrat Alegret
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya-Barcelona, Barcelona, Spain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Agustín Ruiz
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya-Barcelona, Barcelona, Spain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Lluis Tárraga
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya-Barcelona, Barcelona, Spain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Mercè Boada
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya-Barcelona, Barcelona, Spain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Manuel Sarasa
- Araclon Biotech S.L., Vía Hispanidad 21, 50009, Zaragoza, Spain
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Lowe VJ, Lundt ES, Albertson SM, Przybelski SA, Senjem ML, Parisi JE, Kantarci K, Boeve B, Jones DT, Knopman D, Jack CR, Dickson DW, Petersen RC, Murray ME. Neuroimaging correlates with neuropathologic schemes in neurodegenerative disease. Alzheimers Dement 2019; 15:927-939. [PMID: 31175025 DOI: 10.1016/j.jalz.2019.03.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 02/05/2019] [Accepted: 03/07/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Neuroimaging biomarkers are important for early diagnosis of Alzheimer's disease, and comparing multimodality neuroimaging to autopsy data is essential. METHODS We compared the pathologic findings from a prospective autopsy cohort (n = 100) to Pittsburgh compound B PET (PiB-PET), 18F-fluorodeoxyglucose PET (FDG-PET), and MRI. Correlations between neuroimaging biomarkers and neuropathologic schemes were assessed. RESULTS PiB-PET showed strong correlations with Thal amyloid phase and Consortium to Establish a Registry for Alzheimer's Disease score and categorized 44% of Thal phase 1 participants as positive. FDG-PET and MRI correlated modestly with Braak tangle stage in Alzheimer's type pathology. A subset of participants with "none" or "sparse" neuritic plaque scores had elevated PiB-PET signal due to diffuse amyloid plaque. Participants with findings characterized as "suspected non-Alzheimer's pathophysiology" represented 15% of the group. DISCUSSION PiB-PET is associated with Alzheimer's disease, neuritic plaques, and diffuse plaques. FDG-PET and MRI have modest correlation with neuropathologic schemes. Participants with findings characterized as suspected non-Alzheimer's pathophysiology most commonly had primary age-related tauopathy.
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Affiliation(s)
- Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.
| | - Emily S Lundt
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | | | - Matthew L Senjem
- Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | - Joseph E Parisi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Bradley Boeve
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - David T Jones
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - David Knopman
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Bouter C, Vogelgsang J, Wiltfang J. Comparison between amyloid-PET and CSF amyloid-β biomarkers in a clinical cohort with memory deficits. Clin Chim Acta 2019; 492:62-68. [PMID: 30735665 DOI: 10.1016/j.cca.2019.02.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/04/2019] [Accepted: 02/04/2019] [Indexed: 11/25/2022]
Abstract
With increasing prevalence of Alzheimer's disease (AD) and advances in research of therapeutic approaches, an early and accurate in-vivo diagnosis is crucial. Different biomarkers that are able to identify AD are currently in focus. However, whether and to which extend results of cerebrospinal fluid (CSF) and imaging biomarkers are comparable, is unclear. This study aims to correlate CSF and amyloid imaging biomarkers comparing them to cognitive measurements in order to determine whether these methods provide identical or complementary information. The study comprises 33 consecutive patients with suspected cognitive decline that underwent lumbar puncture for CSF biomarker analysis and Amyloid-PET/CT within the diagnostic evaluation of memory impairment. Amyloid PET/CTs were evaluated visually and quantitatively. CSF and imaging data were retrospectively evaluated and results were compared to cognition tests, age, gender, and ApoE status. Global cortex SUVr levels correlated highly with CSF Aβ42/40 and moderately with Aβ42 but not with Aβ40. Global cortex SUVr and Aβ42/40 correlated with mini mental status examination. This study indicates that Amyloid-PET and CSF biomarkers might not reflect identical clinical information and a combination of both seems to be the most accurate way to characterize clinically unclear cognitive decline.
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Affiliation(s)
- Caroline Bouter
- University Medical Center Goettingen (UMG), Georg-August-University, Dept. of Nuclear Medicine, Robert-Koch-Str. 40, D-37075 Goettingen, Germany.
| | - Jonathan Vogelgsang
- University Medical Center Goettingen (UMG), Georg-August-University, Dept. of Psychiatry and Psychotherapy, Von-Siebold-Str. 5, D-37075 Goettingen, Germany
| | - Jens Wiltfang
- University Medical Center Goettingen (UMG), Georg-August-University, Dept. of Psychiatry and Psychotherapy, Von-Siebold-Str. 5, D-37075 Goettingen, Germany; German Center for Neurodegenerative Diseases (DZNE), Von-Siebold-Str. 3a, D-37075 Goettingen, Germany; iBiMED, Medical Science Department, University of Aveiro, Portugal
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19
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Frisoni GB, Barkhof F, Altomare D, Berkhof J, Boccardi M, Canzoneri E, Collij L, Drzezga A, Farrar G, Garibotto V, Gismondi R, Gispert JD, Jessen F, Kivipelto M, Lopes Alves I, Molinuevo JL, Nordberg A, Payoux P, Ritchie C, Savicheva I, Scheltens P, Schmidt ME, Schott JM, Stephens A, van Berckel B, Vellas B, Walker Z, Raffa N. AMYPAD Diagnostic and Patient Management Study: Rationale and design. Alzheimers Dement 2018; 15:388-399. [PMID: 30339801 DOI: 10.1016/j.jalz.2018.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 08/27/2018] [Accepted: 09/06/2018] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Reimbursement of amyloid-positron emission tomography (PET) is lagging due to the lack of definitive evidence on its clinical utility and cost-effectiveness. The Amyloid Imaging to Prevent Alzheimer's Disease-Diagnostic and Patient Management Study (AMYPAD-DPMS) is designed to fill this gap. METHODS AMYPAD-DPMS is a phase 4, multicenter, prospective, randomized controlled study. Nine hundred patients with subjective cognitive decline plus, mild cognitive impairment, and dementia possibly due to Alzheimer's disease will be randomized to ARM1, amyloid-PET performed early in the diagnostic workup; ARM2, amyloid-PET performed after 8 months; and ARM3, amyloid-PET performed whenever the physician chooses to do so. ENDPOINTS The primary endpoint is the difference between ARM1 and ARM2 in the proportion of patients receiving a very-high-confidence etiologic diagnosis after 3 months. Secondary endpoints address diagnosis and diagnostic confidence, diagnostic/therapeutic management, health economics and patient-related outcomes, and methods for image quantitation. EXPECTED IMPACTS AMYPAD-DPMS will supply physicians and health care payers with real-world data to plan management decisions.
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Affiliation(s)
- Giovanni B Frisoni
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland; Memory Clinic, University Hospital of Geneva, Geneva, Switzerland; Laboratory of Alzheimer's Neuroimaging and Epidemiology (LANE), Saint John of God Clinical Research Centre, Brescia, Italy.
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands; Institutes of Neurology and Healthcare Engineering, UCL, London, United Kingdom
| | - Daniele Altomare
- Laboratory of Alzheimer's Neuroimaging and Epidemiology (LANE), Saint John of God Clinical Research Centre, Brescia, Italy; Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Johannes Berkhof
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - Marina Boccardi
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland; Laboratory of Alzheimer's Neuroimaging and Epidemiology (LANE), Saint John of God Clinical Research Centre, Brescia, Italy
| | - Elisa Canzoneri
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
| | - Lyduine Collij
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | - Alexander Drzezga
- Department of Nuclear Medicine, University Hospital of Cologne, University of Cologne and German Center for Neurodegenerative Diseases (DZNE), Germany
| | - Gill Farrar
- Life Sciences, GE Healthcare, Amersham, Buckinghamshire, United Kingdom
| | - Valentina Garibotto
- Division of Nuclear Medicine and Molecular Imaging, Department of Medical Imaging, University Hospitals of Geneva, Geneva, Switzerland; NIMTlab, Faculty of Medicine, Geneva University, Geneva, Switzerland
| | | | - Juan-Domingo Gispert
- Barcelonaβeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Frank Jessen
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany; German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Miia Kivipelto
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden; Aging Theme, Karolinska University Hospital Stockholm, Sweden; University of Eastern Finland, Finland; School of Public Health, Imperial College, London, United Kingdom
| | - Isadora Lopes Alves
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | - José Luis Molinuevo
- Barcelonaβeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain
| | - Agneta Nordberg
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden; Aging Theme, Karolinska University Hospital Stockholm, Sweden
| | - Pierre Payoux
- Nuclear Medicine Department, University Hospital of Toulouse (CHU-Toulouse), Toulouse, France; ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Craig Ritchie
- Centre for Clinical Brain Sciences, Department of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
| | - Irina Savicheva
- Nuclear Medicine IRA, Medical Radiation Physics and Nuclear Medicine Imaging, Karolinska University Hospital, Sweden
| | - Philip Scheltens
- Alzheimer Center and Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | - Mark E Schmidt
- Experimental Medicine, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Jonathan M Schott
- Institute of Neurology, University College London, London, United Kingdom
| | - Andrew Stephens
- Piramal Imaging, Clinical Research and Development, Berlin, Germany
| | - Bart van Berckel
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | - Bruno Vellas
- Gerontopole of Toulouse, University Hospital of Toulouse (CHU-Toulouse), Toulouse, France; UMR INSERM 1027, University of Toulouse III, Toulouse, France
| | - Zuzana Walker
- Division of Psychiatry, University College London, London, United Kingdom; Essex Partnership University NHS Foundation Trust, United Kingdom
| | - Nicola Raffa
- Piramal Imaging, Market Access and HEOR, Berlin, Germany
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Fredericks CA, Sturm VE, Brown JA, Hua AY, Bilgel M, Wong DF, Resnick SM, Seeley WW. Early affective changes and increased connectivity in preclinical Alzheimer's disease. Alzheimers Dement (Amst) 2018; 10:471-479. [PMID: 30302368 PMCID: PMC6174255 DOI: 10.1016/j.dadm.2018.06.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Introduction Affective changes precede cognitive decline in mild Alzheimer's disease and may relate to increased connectivity in a “salience network” attuned to emotionally significant stimuli. The trajectory of affective changes in preclinical Alzheimer's disease, and its relationship to this network, is unknown. Methods One hundred one cognitively normal older adults received longitudinal assessments of affective symptoms, then amyloid-PET. We hypothesized amyloid-positive individuals would show enhanced emotional reactivity associated with salience network connectivity. We tested whether increased global connectivity in key regions significantly related to affective changes. Results In participants later found to be amyloid positive, emotional reactivity increased with age, and interpersonal warmth declined in women. These individuals showed higher global connectivity within the right insula and superior temporal sulcus; higher superior temporal sulcus connectivity predicted increasing emotional reactivity and decreasing interpersonal warmth. Conclusions Affective changes should be considered an early preclinical feature of Alzheimer's disease. These changes may relate to higher functional connectivity in regions critical for social-emotional processing.
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Affiliation(s)
- Carolyn A. Fredericks
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
- Corresponding author. Tel.: 650 721 5357; Fax: 650 725 0390.
| | - Virginia E. Sturm
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Jesse A. Brown
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Alice Y. Hua
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Murat Bilgel
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, USA
| | - Dean F. Wong
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, USA
| | - Susan M. Resnick
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, USA
| | - William W. Seeley
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
- Department of Pathology, University of California, San Francisco, CA, USA
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21
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Cerami C, Dodich A, Iannaccone S, Magnani G, Santangelo R, Presotto L, Marcone A, Gianolli L, Cappa SF, Perani D. A biomarker study in long-lasting amnestic mild cognitive impairment. Alzheimers Res Ther 2018; 10:42. [PMID: 29695292 PMCID: PMC5918759 DOI: 10.1186/s13195-018-0369-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 03/19/2018] [Indexed: 01/09/2023]
Abstract
Background Mild cognitive impairment (MCI) is a heterogeneous syndrome resulting from Alzheimer’s disease (AD) as well as to non-AD and non-neurodegenerative conditions. A subset of patients with amnestic MCI (aMCI) present with an unusually long-lasting course, a slow rate of clinical neuropsychological progression, and evidence of focal involvement of medial temporal lobe structures. In the present study, we explored positron emission tomography (PET) and cerebrospinal fluid (CSF) biomarkers in a sample of subjects with aMCI with such clinical features in order to provide in vivo evidence to improve disease characterisation in this subgroup. Methods Thirty consecutive subjects with aMCI who had long-lasting memory impairment (more than 4 years from symptom onset) and a very slow rate of cognitive progression were included. All subjects underwent fluorodeoxyglucose-positron emission tomography (FDG-PET) metabolic imaging. A measure of cerebral amyloid load, by PET and/or CSF, was obtained in 26 of 30 subjects. The mean clinical follow-up was 58.3 ± 10.1 months. Results No patient progressed to dementia during the follow-up. The typical AD FDG-PET pattern of temporoparietal hypometabolism was not present in any of the subjects. In contrast, a selective medial temporal lobe hypometabolism was present in all subjects, with an extension to frontolimbic regions in some subjects. PET imaging showed absent or low amyloid load in the majority of samples. The values were well below those reported in prodromal AD, and they were slightly elevated in only two subjects, consistent with the CSF β-amyloid (1–42) protein values. Notably, no amyloid load was present in the hippocampal structures. Conclusions FDG-PET and amyloid-PET together with CSF findings questioned AD pathology as a unique neuropathological substrate in this aMCI subgroup with long-lasting disease course. The possibility of alternative pathological conditions, such as argyrophilic grain disease, primary age-related tauopathy or age-related TDP-43 proteinopathy, known to spread throughout the medial temporal lobe and limbic system structures should be considered in these patients with MCI.
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Affiliation(s)
- Chiara Cerami
- Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy. .,Clinical Neuroscience Department, San Raffaele Turro Hospital, Milan, Italy.
| | - Alessandra Dodich
- Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy.,Clinical Neuroscience Department, San Raffaele Turro Hospital, Milan, Italy
| | - Sandro Iannaccone
- Clinical Neuroscience Department, San Raffaele Turro Hospital, Milan, Italy
| | | | | | - Luca Presotto
- Nuclear Medicine Department, San Raffaele Hospital, Milan, Italy
| | - Alessandra Marcone
- Clinical Neuroscience Department, San Raffaele Turro Hospital, Milan, Italy
| | - Luigi Gianolli
- Nuclear Medicine Department, San Raffaele Hospital, Milan, Italy
| | - Stefano F Cappa
- NeTS Center, Istituto Universitario di Studi Superiori, Pavia, Italy.,IRCCS S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Daniela Perani
- Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy.,Nuclear Medicine Department, San Raffaele Hospital, Milan, Italy.,Università Vita-Salute San Raffaele, Milan, Italy
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22
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Pascoal TA, Mathotaarachchi S, Shin M, Park AY, Mohades S, Benedet AL, Kang MS, Massarweh G, Soucy JP, Gauthier S, Rosa-Neto P; Alzheimer’s Disease Neuroimaging Initiative. Amyloid and tau signatures of brain metabolic decline in preclinical Alzheimer's disease. Eur J Nucl Med Mol Imaging 2018; 45:1021-30. [PMID: 29396637 DOI: 10.1007/s00259-018-3933-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 01/02/2018] [Indexed: 01/18/2023]
Abstract
Purpose We aimed to determine the amyloid (Aβ) and tau biomarker levels associated with imminent Alzheimer’s disease (AD) - related metabolic decline in cognitively normal individuals. Methods A threshold analysis was performed in 120 cognitively normal elderly individuals by modelling 2-year declines in brain glucose metabolism measured with [18F]fluorodeoxyglucose ([18F]FDG) as a function of [18F]florbetapir Aβ positron emission tomography (PET) and cerebrospinal fluid phosphorylated tau biomarker thresholds. Additionally, using a novel voxel-wise analytical framework, we determined the sample sizes needed to test an estimated 25% drugeffect with 80% of power on changes in FDG uptake over 2 years at every brain voxel. Results The combination of [18F]florbetapir standardized uptake value ratios and phosphorylated-tau levels more than one standard deviation higher than their respective thresholds for biomarker abnormality was the best predictor of metabolic decline in individuals with preclinical AD. We also found that a clinical trial using these thresholds would require as few as 100 individuals to test a 25% drug effect on AD-related metabolic decline over 2 years. Conclusions These results highlight the new concept that combined Aβ and tau thresholds can predict imminent neurodegeneration as an alternative framework with a high statistical power for testing the effect of disease-modifying therapies on [18F]FDG uptake decline over a typical 2-year clinical trial period in individuals with preclinical AD. Electronic supplementary material The online version of this article (10.1007/s00259-018-3933-3) contains supplementary material, which is available to authorized users.
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23
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Blautzik J, Brendel M, Sauerbeck J, Kotz S, Scheiwein F, Bartenstein P, Seibyl J, Rominger A. Reference region selection and the association between the rate of amyloid accumulation over time and the baseline amyloid burden. Eur J Nucl Med Mol Imaging 2017; 44:1364-1374. [PMID: 28326436 DOI: 10.1007/s00259-017-3666-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 02/24/2017] [Indexed: 10/19/2022]
Abstract
Relative quantitative analysis of amyloid plaque burden in Alzheimer's disease (AD) patients can be reported as standardized uptake value ratio (SUVR) from positron emission tomography (PET). Here, the SUVR is the ratio of the mean amyloid radioligand retention in a composite (COMP) neocortical volume of interest (VOI) to that in a reference VOI, such as the cerebellum, brainstem (BST)/pons, or white matter (WM). Some longitudinal PET investigations show that the rate of amyloid accumulation to follow-up has an inverted U relationship with baseline amyloid SUVR relative to cerebellar or brainstem/pons reference VOIs. The corresponding association with SUVR relative to WM is unknown. To test the possible benefits of WM normalization, we analyzed [18F]-AV45 PET data from 404 subjects in the AD Neuroimaging Initiative (ADNI) database at baseline and 2-year follow-up (144 cognitively normal controls, 225 patients with mild cognitive impairment, and 35 AD patients). Reference regions included subcortical WM as well as conventional cerebellar gray matter (CBL), and BST. We tested associations between each subject's inter-session change (∆) of SUVR and their baseline SUVR by applying linear, logarithmic, and quadratic regression analyses. Unscaled standardized uptake values (SUVs) were correlated between VOIs at baseline and follow-up, and within VOIs in the longitudinal run. The association between ∆SUVR and baseline SUVR relative to WM reference was best described by an inverted U-shaped function. Correlation analyses demonstrated a high regional and temporal correlation between COMP and WM VOI SUVs. For WM normalization, we confirm that the rate of amyloid accumulation over time follows an inverted U-shaped function of baseline amyloid burden. Reference region selection, however, has substantial effects on SUVR results. This reflects the extent of covariance between SUVs in the COMP VOI and those in the various reference VOIs. We speculate that PET labeling of amyloid deposition within target regions is partially confounded by effects of longitudinal changes of cerebral blood flow (CBF) on tracer delivery. Indeed, CBF may be the leading factor influencing longitudinal SUV changes. We suggest that SUVR relative to WM may be more robust to changes in CBF, and thus fitter for sensitive detection of amyloid accumulation in intervention studies.
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Affiliation(s)
- Janusch Blautzik
- Department of Nuclear Medicine, University of Munich, Munich, Germany
| | - Matthias Brendel
- Department of Nuclear Medicine, University of Munich, Munich, Germany
| | - Julia Sauerbeck
- Department of Nuclear Medicine, University of Munich, Munich, Germany
| | - Sebastian Kotz
- Department of Nuclear Medicine, University of Munich, Munich, Germany
| | | | - Peter Bartenstein
- Department of Nuclear Medicine, University of Munich, Munich, Germany
| | | | - Axel Rominger
- Department of Nuclear Medicine, University of Munich, Munich, Germany.
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Weidman DA, Zamrini E, Sabbagh MN, Jacobson S, Burke A, Belden C, Powell J, Bhalla N, Roontiva A, Kuang X, Luo J, Chen K, Riggs G, Burke W. Added value and limitations of amyloid-PET imaging: review and analysis of selected cases of mild cognitive impairment and dementia. Neurocase 2017; 23:41-51. [PMID: 28376695 DOI: 10.1080/13554794.2017.1290806] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Amyloid-positron emission tomography (PET) imaging of the brain detects elevated amyloid-beta (amyloid-β) neuritic plaques in vivo, which can be helpful in appropriately selected cases of mild cognitive impairment (MCI) and dementia, when Alzheimer's disease remains a possible etiology, after a comprehensive clinical evaluation. We reviewed cases of cognitively impaired patients who underwent amyloid-PET imaging because of diagnostic uncertainty. Pre- and post-PET elements of diagnosis and management were first compared, to assess impact of scan results on clinical decision-making, and then an analysis of those decisions was undertaken in appropriate clinical situations, to delineate the added value and limitations of amyloid-PET imaging. The potential benefits and limitations of this diagnostic tool are important to understand in an era when the utility of such scans in clinical practice is evolving.
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Affiliation(s)
- David A Weidman
- a Stead Family Memory Center , Banner Alzheimer's Institute , Phoenix , AZ , USA
| | - Edward Zamrini
- b Cleo Roberts Memory Center , Banner Sun Health Research Institute , Sun City , AZ , USA
| | - Marwan N Sabbagh
- b Cleo Roberts Memory Center , Banner Sun Health Research Institute , Sun City , AZ , USA
| | - Sandra Jacobson
- b Cleo Roberts Memory Center , Banner Sun Health Research Institute , Sun City , AZ , USA
| | - Anna Burke
- a Stead Family Memory Center , Banner Alzheimer's Institute , Phoenix , AZ , USA
| | - Christine Belden
- b Cleo Roberts Memory Center , Banner Sun Health Research Institute , Sun City , AZ , USA
| | - Jessica Powell
- b Cleo Roberts Memory Center , Banner Sun Health Research Institute , Sun City , AZ , USA
| | - Nidhi Bhalla
- b Cleo Roberts Memory Center , Banner Sun Health Research Institute , Sun City , AZ , USA
| | - Auttawut Roontiva
- a Stead Family Memory Center , Banner Alzheimer's Institute , Phoenix , AZ , USA
| | - Xiaoying Kuang
- a Stead Family Memory Center , Banner Alzheimer's Institute , Phoenix , AZ , USA
| | - Ji Luo
- a Stead Family Memory Center , Banner Alzheimer's Institute , Phoenix , AZ , USA
| | - Kewei Chen
- a Stead Family Memory Center , Banner Alzheimer's Institute , Phoenix , AZ , USA
| | - Garrett Riggs
- a Stead Family Memory Center , Banner Alzheimer's Institute , Phoenix , AZ , USA
| | - William Burke
- a Stead Family Memory Center , Banner Alzheimer's Institute , Phoenix , AZ , USA
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25
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Pascoal TA, Mathotaarachchi S, Shin M, Benedet AL, Mohades S, Wang S, Beaudry T, Kang MS, Soucy JP, Labbe A, Gauthier S, Rosa-Neto P. Synergistic interaction between amyloid and tau predicts the progression to dementia. Alzheimers Dement 2016; 13:644-653. [PMID: 28024995 DOI: 10.1016/j.jalz.2016.11.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 09/07/2016] [Accepted: 11/07/2016] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Recent literature proposes that amyloid β (Aβ) and phosphorylated tau (p-tau) synergism accelerates biomarker abnormalities in controls. Yet, it remains to be answered whether this synergism is the driving force behind Alzheimer disease (AD) dementia. METHODS We stratified 314 mild cognitive impairment individuals using [18F]florbetapir positron emission tomography Aβ imaging and cerebrospinal fluid p-tau. Regression and voxel-based logistic regression models with interaction terms evaluated 2-year changes in cognition and clinical status as a function of baseline biomarkers. RESULTS We found that the synergism between [18F]florbetapir and p-tau, rather than their additive effects, was associated with the cognitive decline and progression to AD. Furthermore, voxel-based analysis revealed that temporal and inferior parietal were the regions where the synergism determined an increased likelihood of developing AD. DISCUSSION Together, the present results support that progression to AD dementia is driven by the synergistic rather than a mere additive effect between Aβ and p-tau proteins.
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Affiliation(s)
- Tharick A Pascoal
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Montreal, Canada
| | - Sulantha Mathotaarachchi
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Montreal, Canada
| | - Monica Shin
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Montreal, Canada
| | - Andrea L Benedet
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Montreal, Canada; CAPES Foundation, Ministry of Education of Brazil, Brasília, Brazil
| | - Sara Mohades
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Montreal, Canada
| | - Seqian Wang
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Montreal, Canada
| | - Tom Beaudry
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Montreal, Canada
| | - Min Su Kang
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Montreal, Canada
| | | | - Aurelie Labbe
- Douglas Hospital Research Centre, McGill University, Montreal, Canada; Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Canada
| | - Serge Gauthier
- AD Research Unit, The McGill University Research Centre for Studies in Aging, Montreal, Canada; McGill University, Montreal, Canada
| | - Pedro Rosa-Neto
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Montreal, Canada; Montreal Neurological Institute, Montreal, Canada; AD Research Unit, The McGill University Research Centre for Studies in Aging, Montreal, Canada; McGill University, Montreal, Canada; Department of Neurology and Neurosurgery, McGill University, Montreal, Canada.
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26
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Schönecker S, Brendel M, Huber M, Vollmar C, Huppertz HJ, Teipel S, Okamura N, Levin J, Rominger A, Danek A. Applied multimodal diagnostics in a case of presenile dementia. BMC Neurol 2016; 16:131. [PMID: 27506761 PMCID: PMC4977691 DOI: 10.1186/s12883-016-0647-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 07/26/2016] [Indexed: 12/14/2022] Open
Abstract
Background Alzheimer’s disease (AD) is the most common cause of dementia in the elderly. The possibility of disease-modifying strategies has evoked a need for early and accurate diagnosis. To improve the accuracy of the clinical diagnosis of AD, biomarkers like cerebrospinal fluid (CSF) and neuroimaging techniques like magnetic resonance imaging (MRI) and positron emission tomography (PET) have been incorporated into the diagnostic guidelines of AD. Case presentation In this case report we outline in reference to one of our patients with presenile dementia the current approaches to the diagnosis of AD. The patient was a 59-year old woman presenting with progressive memory decline. CSF-Aβ42 was normal while P-tau was slightly increased. FDG-PET indicated a pattern typical for AD, amyloid-PET showed an extensive global amyloid load, and tau-PET depicted a pronounced hippocampal tracer accumulation. The MRI scan was rated as normal at routine diagnostics, however quantitative volumetric analysis revealed significant atrophy especially of the parietal lobe. The combination of biomarkers and neuroimaging techniques was therefore suggestive of an underlying AD pathology. Conclusions To enable early and accurate diagnosis of AD and thereby also patient recruitment for anti-tau or anti-β-amyloid therapeutic trials, a combination of biomarkers and neuroimaging techniques seems useful.
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Affiliation(s)
- Sonja Schönecker
- Department of Neurology, Ludwig-Maximilians University, Munich, Germany.
| | - Matthias Brendel
- Department of Nuclear Medicine, Ludwig-Maximilians University, Munich, Germany
| | - Marion Huber
- Department of Neurology, Ludwig-Maximilians University, Munich, Germany
| | - Christian Vollmar
- Department of Neurology, Ludwig-Maximilians University, Munich, Germany
| | | | - Stefan Teipel
- Department of Psychosomatic Medicine, University of Rostock, Rostock, Germany.,German Center for Neurodegenerative Diseases, Rostock, Germany
| | - Nobuyuki Okamura
- Department of Pharmacology, Tohoku University School of Medicine, Sendai, Japan
| | - Johannes Levin
- Department of Neurology, Ludwig-Maximilians University, Munich, Germany.,German Center for Neurodegenerative Diseases, Munich, Germany
| | - Axel Rominger
- Department of Nuclear Medicine, Ludwig-Maximilians University, Munich, Germany
| | - Adrian Danek
- Department of Neurology, Ludwig-Maximilians University, Munich, Germany
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27
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Bensaïdane MR, M-P F, Damasse G, Chenard M, Dionne C, Duclos M, Bouchard RW, Laforce R. Clinical Utility of Amyloid Imaging in a Complex Case of Corticobasal Syndrome Presenting with Psychiatric Symptoms. ACTA ACUST UNITED AC 2014. [PMID: 26225355 PMCID: PMC4516413 DOI: 10.4172/2329-6895.1000194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Clinical indications of amyloid imaging in atypical dementia remain unclear. We report a 68-year-old female without past psychiatric history who was hospitalized for auditory hallucinations and persecutory delusions associated with cognitive and motor deficits. Although psychotic symptoms resolved with antipsychotic treatment, cognitive and motor impairments remained. She further showed severe visuoconstructive and executive deficits, ideomotor apraxia, elements of Gerstmann’s syndrome, bilateral agraphesthesia and discrete asymmetric motor deficits. Blood tests were unremarkable. Structural brain imaging revealed diffuse fronto-temporo-parietal atrophy, which was most severe in the parietal regions. Meanwhile, FDG-PET suggested asymmetrical fronto-temporo-parietal hypometabolism, with sparing of the posterior cingulate gyrus. A diagnosis of possible corticobasal syndrome (CBS) was made. Amyloid-PET using the novel tracer NAV4694 was ordered, and revealed significant deposition of fibrillar amyloid (SUVR 2.05). The primary diagnosis was CBS with underlying Alzheimer pathology and treatment with a cholinesterase inhibitor was initiated. Determination of underlying pathological CBS subtype is not simple even when based on extensive investigation including clinical presentation, atrophy patterns on MRI, and regional hypometabolism on FDG-PET. By contrast, amyloid imaging quickly confirmed Alzheimer pathology, and allowed rapid initiation of treatment in this complex case with early psychiatric symptoms. This case study illustrates the clinical utility of amyloid imaging in the setting of atypical cases seen in a tertiary memory clinic.
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Affiliation(s)
- M R Bensaïdane
- Faculty of Medicine, Laval University, Quebec City, QC, Canada ; Clinique Interdisciplinaire de Mémoire, Centre Hospitalier Universitaire (CHU) de Québec, Quebec City, QC, Canada
| | - Fortin M-P
- Clinique Interdisciplinaire de Mémoire, Centre Hospitalier Universitaire (CHU) de Québec, Quebec City, QC, Canada
| | - G Damasse
- Clinique Interdisciplinaire de Mémoire, Centre Hospitalier Universitaire (CHU) de Québec, Quebec City, QC, Canada
| | - M Chenard
- Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - C Dionne
- Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - M Duclos
- Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - R W Bouchard
- Clinique Interdisciplinaire de Mémoire, Centre Hospitalier Universitaire (CHU) de Québec, Quebec City, QC, Canada
| | - R Laforce
- Clinique Interdisciplinaire de Mémoire, Centre Hospitalier Universitaire (CHU) de Québec, Quebec City, QC, Canada
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