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Cerebral metabolic changes accompanying conversion of mild cognitive impairment into Alzheimer's disease: a PET follow-up study

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Abstract

A high percentage of patients with mild cognitive impairment (MCI) develop clinical dementia of the Alzheimer type (AD) within 1 year. The aim of this longitudinal study was to identify characteristic patterns of cerebral metabolism at baseline in patients converting from MCI to AD, and to evaluate the changes in these patterns over time. Baseline and follow-up examinations after 1 year were performed in 22 MCI patients (12 males, 10 females, aged 69.8±5.8 years); these examinations included neuropsychological testing, structural cranial magnetic resonance imaging and fluorine-18 fluorodeoxyglucose positron emission tomography (PET) evaluation of relative cerebral glucose metabolic rate (rCMRglc). Individual PET scans were stereotactically normalised with NEUROSTAT software (Univ. of Michigan, Ann Arbor, USA). Subsequently, statistical comparison of PET data with an age-matched healthy control population and between patient subgroups was performed using SPM 99 (Wellcome Dept. of Neuroimaging Sciences, London, UK). After 1 year, eight patients (36%) had developed probable AD (referred to as MCIAD), whereas 12 (55%) were still classified as having stable MCI (referred to as MCIMCI). Compared with the healthy control group, a reduced rCMRglc in AD-typical regions, including the temporoparietal and posterior cingulate cortex, was detected at baseline in patients with MCIAD. Abnormalities in the posterior cingulate cortex reached significance even in comparison with the MCIMCI group. After 1 year, MCIAD patients demonstrated an additional bilateral reduction of rCMRglc in prefrontal areas, along with a further progression of the abnormalities in the parietal and posterior cingulate cortex. No such changes were observed in the MCIMCI group. In patients with MCI, characteristic cerebral metabolic differences can be delineated at the time of initial presentation, which helps to define prognostic subgroups. A newly emerging reduction of rCMRglc in prefrontal cortical areas is associated with the transition from MCI to AD.

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Acknowledgements

We thank Brigitte Dzewas and Coletta Kruschke for their technical assistance and the radiochemistry group for their reliable supply of radiopharmaceuticals. We are obliged to Jodi Neverve for the very careful review of the manuscript.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675, München, Germany

    Alexander Drzezga, Frode Willoch & Markus Schwaiger

  2. Department of Psychiatry and Psychotherapy, Technische Universität München, München, Germany

    Nicola Lautenschlager, Matthias Riemenschneider & Alexander Kurz

  3. Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, London, UK

    Hartwig Siebner

  4. Department of Radiology, University of Washington, Seattle, Wash., USA

    Satoshi Minoshima

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  1. Alexander Drzezga
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Correspondence to Alexander Drzezga.

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Drzezga, A., Lautenschlager, N., Siebner, H. et al. Cerebral metabolic changes accompanying conversion of mild cognitive impairment into Alzheimer's disease: a PET follow-up study. Eur J Nucl Med Mol Imaging 30, 1104–1113 (2003). https://doi.org/10.1007/s00259-003-1194-1

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  • DOI: https://doi.org/10.1007/s00259-003-1194-1

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