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Cognitive trajectories of patients with focal ß-amyloid deposition

Kim SE 1 , Lee B 2 , Jang H 1 , Chin J 1 , Khoo CS 3 , Choe YS 1 Show all authors , Kim JS 1 , Kang SH 1 , Kim HR 1 , Hwangbo S 1 , Jeong JH 4 , Yoon SJ 5 , Park KW 6 , Kim EJ 7 , Yoon B 8 , Jang JW 9 , Hong JY 10 , Na DL 1 , Seo SW 1 , Choi SH 11 , Kim HJ 12

Affiliations 

  • 1 Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  • 2 Department of Neurology, Yuseong Geriatric Rehabilitation Hospital, Pohang, Korea
  • 3 Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
  • 4 Department of Neurology, Ewha Womans University Seoul Hospital, Ewha Womans University School of Medicine, Seoul, Korea
  • 5 Department of Neurology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
  • 6 Department of Neurology, Dong-A Medical Center, Dong-A University College of Medicine, Busan, Korea
  • 7 Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Korea
  • 8 Department of Neurology, Konyang University College of Medicine, Daejeon, Korea
  • 9 Department of Neurology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea
  • 10 Department of Neurology, Yonsei University Wonju College of Medicine, Wonju, Korea
  • 11 Department of Neurology, Inha University School of Medicine, Incheon, Korea
  • 12 Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. evekhj@gmail.com
Alzheimers Res Ther, 2021 02 19;13(1):48.
PMID: 33608041 DOI: 10.1186/s13195-021-00787-7

Abstract

BACKGROUND: The presence of ß-amyloid (Aß) in the brain can be identified using amyloid PET. In clinical practice, the amyloid PET is interpreted based on dichotomous visual rating, which renders focal Aß accumulation be read as positive for Aß. However, the prognosis of patients with focal Aß deposition is not well established. Thus, we investigated cognitive trajectories of patients with focal Aß deposition.

METHODS: We followed up 240 participants (112 cognitively unimpaired [CU], 78 amnestic mild cognitive impairment [aMCI], and 50 Alzheimer's disease (AD) dementia [ADD]) for 2 years from 9 referral centers in South Korea. Participants were assessed with neuropsychological tests and 18F-flutemetamol (FMM) positron emission tomography (PET). Ten regions (frontal, precuneus/posterior cingulate (PPC), lateral temporal, parietal, and striatum of each hemisphere) were visually examined in the FMM scan, and participants were divided into three groups: No-FMM, Focal-FMM (FMM uptake in 1-9 regions), and Diffuse-FMM. We used mixed-effects model to investigate the speed of cognitive decline in the Focal-FMM group according to the cognitive level, extent, and location of Aß involvement, in comparison with the No- or Diffuse-FMM group.

RESULTS: Forty-five of 240 (18.8%) individuals were categorized as Focal-FMM. The rate of cognitive decline in the Focal-FMM group was faster than the No-FMM group (especially in the CU and aMCI stage) and slower than the Diffuse-FMM group (in particular in the CU stage). Within the Focal-FMM group, participants with FMM uptake to a larger extent (7-9 regions) showed faster cognitive decline compared to those with uptake to a smaller extent (1-3 or 4-6 regions). The Focal-FMM group was found to have faster cognitive decline in comparison with the No-FMM when there was uptake in the PPC, striatum, and frontal cortex.

CONCLUSIONS: When predicting cognitive decline of patients with focal Aß deposition, the patients' cognitive level, extent, and location of the focal involvement are important.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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