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Heterogeneity of Brain Glucose Metabolism in Mild Cognitive Impairment and Clinical Progression to Alzheimer Disease
Davide Anchisi, MD, PhD;
Barbara Borroni, MD;
Massimo Franceschi, MD;
Nasser Kerrouche, MA, PhD;
Elke Kalbe, PhD;
Bettina Beuthien-Beumann, MD;
Stephano Cappa, MD;
Olaf Lenz, MD;
Stephan Ludecke, MD;
Alessandra Marcone, MD;
Rüdiger Mielke, MD;
Paola Ortelli, MA;
Alessandro Padovani, MD, PhD;
Oriana Pelati, MA;
Alberto Pupi, MD;
Elio Scarpini, MD;
Simon Weisenbach, MD;
Karl Herholz, MD;
Erik Salmon, MD;
Vjera Holthoff, MD;
Sandro Sorbi, MD;
Ferruccio Fazio, MD;
Daniela Perani, MD
Arch Neurol. 2005;62:1728-1733.
Background Subjects with amnesic mild cognitive impairment (aMCI) may include patients at high risk for progression to Alzheimer disease (AD) and a population with different underlying pathologic conditions.
Objective To evaluate the potential roles of positron emission tomography with fluodeoxyglucose F 18 (18FDG-PET) and memory scores in identifying subjects with aMCI and in predicting progression to dementia.
Design, Setting, and Patients Sixty-seven patients at European centers for neurologic and AD care who were diagnosed as having aMCI each underwent an extensive clinical and neuropsychological examination and an 18FDG-PET study. Forty-eight subjects were followed up periodically for at least 1 year, and progression to dementia was evaluated.
Main Outcome Measures Brain glucose metabolism and memory scores.
Results Fourteen subjects with aMCI who converted to AD within 1 year showed bilateral hypometabolism in the inferior parietal, posterior cingulate, and medial temporal cortex. Subjects with "stable" aMCI presented with hypometabolism in the dorsolateral frontal cortex. The severity of memory impairment, as evaluated by the California Verbal Learning Test–Long Delay Free Recall scores, correlated with the following brain metabolic patterns: scores less than 7 were associated with a typical 18FDG-PET AD pattern, and scores of 7 or higher were associated with hypometabolism in the dorsolateral frontal cortex and no progression to AD.
Conclusion These data provide evidence for clinical and functional heterogeneity among subjects with aMCI and suggest that 18FDG-PET findings combined with memory scores may be useful in predicting short-term conversion to AD.
Author Affiliations: Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele (Dr Anchisi), Institute of Bioimaging and Molecular Physiology–Consiglio Nazionale delle Ricereche, Institute H San Raffaele, Vita Salute San Raffaele University and Milano-Bicocca University, Milan (Drs Cappa, Marcone, Fazio, and Perani and Ms Ortelli), and Department of Neurological Sciences, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Maggiore Policlinico, University of Milan (Dr Scarpini), Milan; Department of Neurology, University of Brescia, Brescia (Drs Borroni and Padovani); Department of Neurology, Multimedica S Maria, Castellanza, Varese (Dr Franceschi and Ms Pelati); and Departments of Clinical Pathophysiology (Drs Pupi and Sorbi) and Neurological and Psychiatric Sciences (Dr Sorbi), University of Florence, Florence; Italy; National Institute for Health and Medical Research (Institut National de la Santé et de la Recherche Médicale), Unit 320, Caen, France (Dr Kerrouche); Neurological Clinic and Max-Planck-Institute for Neurological Research, University of Cologne, Cologne (Drs Kalbe, Lenz, Mielke, Weisenbach, and Herholz), and Departments of Nuclear Medicine (Dr Beuthien-Beumann) and Psychiatry and Psychotherapy (Drs Ludecke and Holthoff), University of Technology, and Positron Emission Tomography Center, Research Center Rossendorf (Dr Beuthien-Beumann), Dresden; Germany; and Cyclotron Research, Center and Service of Neurology, University of Liège, Liège, Belgium (Dr Salmon).
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