Prediction of Outcomes in Mild Cognitive Impairment by Using ¹⁸F-FDG-PET: A Multicenter Study

Article type: Research Article

Authors: Ito, Kengo^{a; b; *} | Fukuyama, Hidenao^c | Senda, Michio^d | Ishii, Kazunari^e | Maeda, Kiyoshi^f | Yamamoto, Yasuji^g | Ouchi, Yasuomi^h | Ishii, Kenjiⁱ | Okumura, Ayumu^j | Fujiwara, Ken^a | Kato, Takashi^a | Arahata, Yutaka^k | Washimi, Yukihiko^k | Mitsuyama, Yoshio^l | Meguro, Kenichi^m | Ikeda, Mitsuruⁿ | SEAD-J Study Group

Affiliations: [a] Department of Clinical and Experimental Neuroimaging, National Center for Geriatrics and Gerontology, Aichi, Japan | [b] Department of Radiology, National Center for Geriatrics and Gerontology, Aichi, Japan | [c] Human Brain Research Center, Kyoto University, Kyoto, Japan | [d] Division of Molecular Imaging, Institute of Biomedical Research and Innovation, Kobe, Japan | [e] Department of Radiology, Kinki University, Osaka, Japan | [f] Department of Medical Rehabilitation, Kobe Gakuin University, Kobe, Japan | [g] Department of Psychiatry, Kobe University Graduate School of Medicine, Kobe, Japan | [h] Medical Photonics Research Center, Hamamatsu University School of Medicine, Hamamatsu, Japan | [i] Positron Medical Center, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan | [j] Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital, Gifu, Japan | [k] National Hospital for Geriatric Medicine, National Center for Geriatrics and Gerontology, Aichi, Japan | [l] Psychogeriatric Center, Daigo Hospital, Miyazaki, Japan | [m] Department of Geriatric Behavioral Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan | [n] Department of Radiological Technology, Nagoya University School of Health Sciences, Nagoya, Japan

Correspondence: [*] Correspondence to: Kengo Ito, Department of Clinical and Experimental Neuroimaging, National Center for Geriatrics and Gerontology, 7-430, Morioka-cho, Obu-shi, Aichi 474-8511, Japan. Tel.: +81 562 46 2311; Fax: +81 562 44 6596; E-mail: [email protected].

Abstract: Background:18F-FDG-PET is defined as a biomarker of neuronal injury according to the revised National Institute on Aging–Alzheimer’s Association criteria. Objective:The objective of this multicenter prospective cohort study was to examine the value of 18F-FDG-PET in predicting the development of Alzheimer’s disease (AD) in patients with mild cognitive impairment (MCI). Methods:In total, 114 patients with MCI at 9 participating institutions underwent clinical and neuropsychological examinations, MRI, and 18F-FDG-PET at baseline. The cases were visually classified into predefined dementia patterns by three experts. An automated analysis for 18F-FDG-PET was also performed to calculate the PET score. Subjects were followed periodically for 3 years, and progression to dementia was evaluated. Results:In 47% of the patients with MCI, progression of symptoms justified the clinical diagnosis of “probable AD”. The PET visual interpretation predicted conversion to AD during 3-year follow-up with an overall diagnostic accuracy of 68%. Overall diagnostic accuracy of the PET score was better than that of PET visual interpretation at all follow-up intervals, and the optimized PET score threshold revealed the best performance at the 2-year follow-up interval with an overall diagnostic accuracy of 83%, a sensitivity of 70%, and a specificity of 90%. Multivariate logistic regression analysis identified the PET score as the most significant predictive factor distinguishing AD converters from non-converters. Conclusion:The PET score is the most statistically significant predictive factor for conversion from MCI to AD, and the diagnostic performance of the PET score is more promising for rapid converters over 2 years.

Keywords: Alzheimer's disease, cerebral glucose metabolism, ¹⁸F-FDG-PET, mild cognitive impairment, prospective study

DOI: 10.3233/JAD-141338

Journal: Journal of Alzheimer's Disease, vol. 45, no. 2, pp. 543-552, 2015