FDG-PET changes in brain glucose metabolism from normal cognition to pathologically verified Alzheimer's disease.
OBJECTIVE
We report the first clinicopathological series of longitudinal FDG-PET scans in post-mortem (PM) verified cognitively normal elderly (NL) followed to the onset of Alzheimer's-type dementia (DAT), and in patients with mild DAT with progressive cognitive deterioration.


METHODS
Four NL subjects and three patients with mild DAT received longitudinal clinical, neuropsychological and dynamic FDG-PET examinations with arterial input functions. NL subjects were followed for 13 +/- 5 years, received FDG-PET examinations over 7 +/- 2 years, and autopsy 6 +/- 3 years after the last FDG-PET. Two NL declined to mild cognitive impairment (MCI), and two developed probable DAT before death. DAT patients were followed for 9 +/- 3 years, received FDG-PET examinations over 3 +/- 2 years, and autopsy 7 +/- 1 years after the last FDG-PET. Two DAT patients progressed to moderate-to-severe dementia and one developed vascular dementia.


RESULTS
The two NL subjects who declined to DAT received a PM diagnosis of definite AD. Their FDG-PET scans indicated a progression of deficits in the cerebral metabolic rate for glucose (CMRglc) from the hippocampus to the parietotemporal and posterior cingulate cortices. One DAT patient showed AD with diffuse Lewy body disease (LBD) at PM, and her last in vivo PET was indicative of possible LBD for the presence of occipital as well as parietotemporal hypometabolism.


CONCLUSIONS
Progressive CMRglc reductions on FDG-PET occur years in advance of clinical DAT symptoms in patients with pathologically verified disease. The FDG-PET profiles in life were consistent with the PM diagnosis.
Mosconi
Lisa
L
Department of Psychiatry, New York University School of Medicine, New York, NY 10016, USA. lisa.mosconi@med.nyu.edu
Mistur
Rachel
R
Switalski
Remigiusz
R
Tsui
Wai Hon
WH
Glodzik
Lidia
L
Li
Yi
Y
Pirraglia
Elizabeth
E
De Santi
Susan
S
Reisberg
Barry
B
Wisniewski
Thomas
T
de Leon
Mony J
MJ
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D001344:Autopsy; D001921:Brain / Q000378:metabolism*; D003072:Cognition Disorders / Q000175:diagnosis / Q000000981:diagnostic imaging; D015140:Dementia, Vascular / Q000175:diagnosis / Q000000981:diagnostic imaging; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000494:pharmacology*; D005947:Glucose / Q000378:metabolism*; D006624:Hippocampus / Q000378:metabolism; D006801:Humans; D020961:Lewy Body Disease / Q000378:metabolism; D008297:Male; D049268:Positron-Emission Tomography / Q000379:methods*
D019788:Fluorodeoxyglucose F18; D005947:Glucose