Brain PET Amyloid and Neurodegeneration Biomarkers in the Context of the 2018 NIA-AA Research Framework: an Individual Approach Exploring Clinical-biomarker Mismatches and Sociodemographic Parameters

Overview

Journal Eur J Nucl Med Mol Imaging

Specialties Biophysics
Nuclear Medicine
Radiology

Date 2020 Feb 15

PMID 32055966

Citations 14

Authors

Artur Martins Coutinho

Geraldo F Busatto

Fabio Henrique de Gobbi Porto

Daniele de Paula Faria

Carla Rachel Ono

Alexandre Teles Garcez

Paula Squarzoni

Fabio Luiz de Souza Duran

Maira Okada de Oliveira

Eduardo Sturzeneker Tres

Sonia Maria Dozzi Brucki

Orestes Vicente Forlenza

Ricardo Nitrini

Carlos Alberto Buchpiguel

Affiliations

Soon will be listed here.

Abstract

Purpose: [F]FDG-PET and [C]PIB-PET are validated as neurodegeneration and amyloid biomarkers of Alzheimer's disease (AD). We used a PET staging system based on the 2018 NIA-AA research framework to compare the proportion of amyloid positivity (A+) and hypometabolism ((N)+) in cases of mild probable AD, amnestic mild cognitive impairment (aMCI), and healthy controls, incorporating an additional classification of abnormal [F]FDG-PET patterns and investigating the co-occurrence of such with A+, exploring [F]FDG-PET to generate hypotheses in cases presenting with clinical-biomarker "mismatches."

Methods: Elderly individuals (N = 108) clinically classified as controls (N = 27), aMCI (N = 43) or mild probable AD (N = 38) were included. Authors assessed their A(N) profiles and classified [F]FDG-PET neurodegenerative patterns as typical or non-typical of AD, performing re-assessments of images whenever clinical classification was in disagreement with the PET staging (clinical-biomarker "mismatches"). We also investigated associations between "mismatches" and sociodemographic and educational characteristics.

Results: AD presented with higher rates of A+ and (N)+. There was also a higher proportion of A+ and (N)+ individuals in the aMCI group in comparison to controls, however without statistical significance regarding the A staging. There was a significant association between amyloid positivity and AD (N)+ hypometabolic patterns typical of AD. Non-AD (N)+ hypometabolism was seen in all A- (N)+ cases in the mild probable AD and control groups and [F]FDG-PET patterns classified such individuals as "SNAP" and one as probable frontotemporal lobar degeneration. All A- (N)- cases in the probable AD group had less than 4 years of formal education and lower socioeconomic status (SES).

Conclusion: The PET-based staging system unveiled significant A(N) differences between AD and the other groups, whereas aMCI and controls had different (N) staging, explaining the cognitive impairment in aMCI. [F]FDG-PET could be used beyond simple (N) staging, since it provided alternative hypotheses to cases with clinical-biomarker "mismatches." An AD hypometabolic pattern correlated with amyloid positivity. Low education and SES were related to dementia in the absence of biomarker changes.

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