Clinical significance of focal ß-amyloid deposition measured by 18F-flutemetamol PET

Si Eun Kim; Byungju Lee; Seongbeom Park; Soo Hyun Cho; Seung Joo Kim; Yeshin Kim; Hyemin Jang; Jee Hyang Jeong; Soo Jin Yoon; Kyung Won Park; Eun Joo Kim; Na Yeon Jung; Bora Yoon; Jae Won Jang; Jin Yong Hong; Jihye Hwang; Duk L. Na; Sang Won Seo; Seong Hye Choi; Hee Jin Kim

doi:10.1186/s13195-019-0577-x

Clinical significance of focal ß-amyloid deposition measured by ¹⁸F-flutemetamol PET

Si Eun Kim, Byungju Lee, Seongbeom Park, Soo Hyun Cho, Seung Joo Kim, Yeshin Kim, Hyemin Jang, Jee Hyang Jeong, Soo Jin Yoon, Kyung Won Park, Eun Joo Kim, Na Yeon Jung, Bora Yoon, Jae Won Jang, Jin Yong Hong, Jihye Hwang, Duk L. Na, Sang Won Seo, Seong Hye Choi, Hee Jin Kim

Department of Neurology

Research output: Contribution to journal › Article › peer-review

13 Scopus citations

Abstract

Background: Although amyloid PET of typical Alzheimer's disease (AD) shows diffuse ß-amyloid (Aß) deposition, some patients show focal deposition. The clinical significance of this focal Aß is not well understood. We examined the clinical significance of focal Aß deposition in terms of cognition as well as Aß and tau cerebrospinal fluid (CSF) levels. We further evaluated the order of Aß accumulation by visual assessment. Methods: We included 310 subjects (125 cognitively unimpaired, 125 mild cognitive impairment, and 60 AD dementia) from 9 referral centers. All patients underwent neuropsychological tests and ¹⁸F-flutemetamol (FMM) PET. Seventy-seven patients underwent CSF analysis. Each FMM scan was visually assessed in 10 regions (frontal, precuneus and posterior cingulate, lateral temporal, parietal, and striatum of each hemisphere) and was classified into three groups: No-FMM, Focal-FMM (FMM uptake in 1-9 regions), and Diffuse-FMM (FMM uptake in all 10 regions). Results: 53/310 (17.1%) subjects were classified as Focal-FMM. The cognitive level of the Focal-FMM group was better than that of Diffuse-FMM group and worse than that of No-FMM group. Among the Focal-FMM group, those who had FMM uptake to a larger extent or in the striatum had worse cognitive levels. Compared to the Diffuse-FMM group, the Focal-FMM group had a less AD-like CSF profile (increased Aß42 and decreased t-tau, t-tau/Aß42). Among the Focal-FMM group, Aß deposition was most frequently observed in the frontal (62.3%) and least frequently observed in the striatum (43.4%) and temporal (39.6%) regions. Conclusions: We suggest that focal Aß deposition is an intermediate stage between no Aß and diffuse Aß deposition. Furthermore, among patients with focal Aß deposition, those who have Aß to a larger extent and striatal involvement show clinical features close to diffuse Aß deposition. Further longitudinal studies are needed to evaluate the disease progression of patients with focal Aß deposition.

Original language	English
Article number	6
Journal	Alzheimer's Research and Therapy
Volume	12
Issue number	1
DOIs	https://doi.org/10.1186/s13195-019-0577-x
State	Published - 4 Jan 2020

Bibliographical note

Publisher Copyright:
© 2020 The Author(s).

Keywords

Alzheimer's disease
Cerebrospinal fluid
Cognition
F-flutemetamol PET
ß-amyloid

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10.1186/s13195-019-0577-x

Cite this

Kim, S. E., Lee, B., Park, S., Cho, S. H., Kim, S. J., Kim, Y., Jang, H., Jeong, J. H., Yoon, S. J., Park, K. W., Kim, E. J., Jung, N. Y., Yoon, B., Jang, J. W., Hong, J. Y., Hwang, J., Na, D. L., Seo, S. W., Choi, S. H., & Kim, H. J. (2020). Clinical significance of focal ß-amyloid deposition measured by ¹⁸F-flutemetamol PET. Alzheimer's Research and Therapy, 12(1), Article 6. https://doi.org/10.1186/s13195-019-0577-x

@article{f65cda3ce0fb403aa43ce0232827f784,

title = "Clinical significance of focal {\ss}-amyloid deposition measured by 18F-flutemetamol PET",

abstract = "Background: Although amyloid PET of typical Alzheimer's disease (AD) shows diffuse {\ss}-amyloid (A{\ss}) deposition, some patients show focal deposition. The clinical significance of this focal A{\ss} is not well understood. We examined the clinical significance of focal A{\ss} deposition in terms of cognition as well as A{\ss} and tau cerebrospinal fluid (CSF) levels. We further evaluated the order of A{\ss} accumulation by visual assessment. Methods: We included 310 subjects (125 cognitively unimpaired, 125 mild cognitive impairment, and 60 AD dementia) from 9 referral centers. All patients underwent neuropsychological tests and 18F-flutemetamol (FMM) PET. Seventy-seven patients underwent CSF analysis. Each FMM scan was visually assessed in 10 regions (frontal, precuneus and posterior cingulate, lateral temporal, parietal, and striatum of each hemisphere) and was classified into three groups: No-FMM, Focal-FMM (FMM uptake in 1-9 regions), and Diffuse-FMM (FMM uptake in all 10 regions). Results: 53/310 (17.1%) subjects were classified as Focal-FMM. The cognitive level of the Focal-FMM group was better than that of Diffuse-FMM group and worse than that of No-FMM group. Among the Focal-FMM group, those who had FMM uptake to a larger extent or in the striatum had worse cognitive levels. Compared to the Diffuse-FMM group, the Focal-FMM group had a less AD-like CSF profile (increased A{\ss}42 and decreased t-tau, t-tau/A{\ss}42). Among the Focal-FMM group, A{\ss} deposition was most frequently observed in the frontal (62.3%) and least frequently observed in the striatum (43.4%) and temporal (39.6%) regions. Conclusions: We suggest that focal A{\ss} deposition is an intermediate stage between no A{\ss} and diffuse A{\ss} deposition. Furthermore, among patients with focal A{\ss} deposition, those who have A{\ss} to a larger extent and striatal involvement show clinical features close to diffuse A{\ss} deposition. Further longitudinal studies are needed to evaluate the disease progression of patients with focal A{\ss} deposition.",

keywords = "Alzheimer's disease, Cerebrospinal fluid, Cognition, F-flutemetamol PET, {\ss}-amyloid",

author = "Kim, {Si Eun} and Byungju Lee and Seongbeom Park and Cho, {Soo Hyun} and Kim, {Seung Joo} and Yeshin Kim and Hyemin Jang and Jeong, {Jee Hyang} and Yoon, {Soo Jin} and Park, {Kyung Won} and Kim, {Eun Joo} and Jung, {Na Yeon} and Bora Yoon and Jang, {Jae Won} and Hong, {Jin Yong} and Jihye Hwang and Na, {Duk L.} and Seo, {Sang Won} and Choi, {Seong Hye} and Kim, {Hee Jin}",

note = "Publisher Copyright: {\textcopyright} 2020 The Author(s).",

year = "2020",

month = jan,

day = "4",

doi = "10.1186/s13195-019-0577-x",

language = "English",

volume = "12",

journal = "Alzheimer's Research and Therapy",

issn = "1758-9193",

publisher = "BioMed Central Ltd.",

number = "1",

}

Kim, SE, Lee, B, Park, S, Cho, SH, Kim, SJ, Kim, Y, Jang, H, Jeong, JH, Yoon, SJ, Park, KW, Kim, EJ, Jung, NY, Yoon, B, Jang, JW, Hong, JY, Hwang, J, Na, DL, Seo, SW, Choi, SH & Kim, HJ 2020, 'Clinical significance of focal ß-amyloid deposition measured by ¹⁸F-flutemetamol PET', Alzheimer's Research and Therapy, vol. 12, no. 1, 6. https://doi.org/10.1186/s13195-019-0577-x

TY - JOUR

T1 - Clinical significance of focal ß-amyloid deposition measured by 18F-flutemetamol PET

AU - Kim, Si Eun

AU - Lee, Byungju

AU - Park, Seongbeom

AU - Cho, Soo Hyun

AU - Kim, Seung Joo

AU - Kim, Yeshin

AU - Jang, Hyemin

AU - Jeong, Jee Hyang

AU - Yoon, Soo Jin

AU - Park, Kyung Won

AU - Kim, Eun Joo

AU - Jung, Na Yeon

AU - Yoon, Bora

AU - Jang, Jae Won

AU - Hong, Jin Yong

AU - Hwang, Jihye

AU - Na, Duk L.

AU - Seo, Sang Won

AU - Choi, Seong Hye

AU - Kim, Hee Jin

PY - 2020/1/4

Y1 - 2020/1/4

N2 - Background: Although amyloid PET of typical Alzheimer's disease (AD) shows diffuse ß-amyloid (Aß) deposition, some patients show focal deposition. The clinical significance of this focal Aß is not well understood. We examined the clinical significance of focal Aß deposition in terms of cognition as well as Aß and tau cerebrospinal fluid (CSF) levels. We further evaluated the order of Aß accumulation by visual assessment. Methods: We included 310 subjects (125 cognitively unimpaired, 125 mild cognitive impairment, and 60 AD dementia) from 9 referral centers. All patients underwent neuropsychological tests and 18F-flutemetamol (FMM) PET. Seventy-seven patients underwent CSF analysis. Each FMM scan was visually assessed in 10 regions (frontal, precuneus and posterior cingulate, lateral temporal, parietal, and striatum of each hemisphere) and was classified into three groups: No-FMM, Focal-FMM (FMM uptake in 1-9 regions), and Diffuse-FMM (FMM uptake in all 10 regions). Results: 53/310 (17.1%) subjects were classified as Focal-FMM. The cognitive level of the Focal-FMM group was better than that of Diffuse-FMM group and worse than that of No-FMM group. Among the Focal-FMM group, those who had FMM uptake to a larger extent or in the striatum had worse cognitive levels. Compared to the Diffuse-FMM group, the Focal-FMM group had a less AD-like CSF profile (increased Aß42 and decreased t-tau, t-tau/Aß42). Among the Focal-FMM group, Aß deposition was most frequently observed in the frontal (62.3%) and least frequently observed in the striatum (43.4%) and temporal (39.6%) regions. Conclusions: We suggest that focal Aß deposition is an intermediate stage between no Aß and diffuse Aß deposition. Furthermore, among patients with focal Aß deposition, those who have Aß to a larger extent and striatal involvement show clinical features close to diffuse Aß deposition. Further longitudinal studies are needed to evaluate the disease progression of patients with focal Aß deposition.

AB - Background: Although amyloid PET of typical Alzheimer's disease (AD) shows diffuse ß-amyloid (Aß) deposition, some patients show focal deposition. The clinical significance of this focal Aß is not well understood. We examined the clinical significance of focal Aß deposition in terms of cognition as well as Aß and tau cerebrospinal fluid (CSF) levels. We further evaluated the order of Aß accumulation by visual assessment. Methods: We included 310 subjects (125 cognitively unimpaired, 125 mild cognitive impairment, and 60 AD dementia) from 9 referral centers. All patients underwent neuropsychological tests and 18F-flutemetamol (FMM) PET. Seventy-seven patients underwent CSF analysis. Each FMM scan was visually assessed in 10 regions (frontal, precuneus and posterior cingulate, lateral temporal, parietal, and striatum of each hemisphere) and was classified into three groups: No-FMM, Focal-FMM (FMM uptake in 1-9 regions), and Diffuse-FMM (FMM uptake in all 10 regions). Results: 53/310 (17.1%) subjects were classified as Focal-FMM. The cognitive level of the Focal-FMM group was better than that of Diffuse-FMM group and worse than that of No-FMM group. Among the Focal-FMM group, those who had FMM uptake to a larger extent or in the striatum had worse cognitive levels. Compared to the Diffuse-FMM group, the Focal-FMM group had a less AD-like CSF profile (increased Aß42 and decreased t-tau, t-tau/Aß42). Among the Focal-FMM group, Aß deposition was most frequently observed in the frontal (62.3%) and least frequently observed in the striatum (43.4%) and temporal (39.6%) regions. Conclusions: We suggest that focal Aß deposition is an intermediate stage between no Aß and diffuse Aß deposition. Furthermore, among patients with focal Aß deposition, those who have Aß to a larger extent and striatal involvement show clinical features close to diffuse Aß deposition. Further longitudinal studies are needed to evaluate the disease progression of patients with focal Aß deposition.

KW - Alzheimer's disease

KW - Cerebrospinal fluid

KW - Cognition

KW - F-flutemetamol PET

KW - ß-amyloid

UR - http://www.scopus.com/inward/record.url?scp=85077480316&partnerID=8YFLogxK

U2 - 10.1186/s13195-019-0577-x

DO - 10.1186/s13195-019-0577-x

M3 - Article

C2 - 31901233

AN - SCOPUS:85077480316

SN - 1758-9193

VL - 12

JO - Alzheimer's Research and Therapy

JF - Alzheimer's Research and Therapy

IS - 1

M1 - 6

ER -