title: Indicators of amyloid burden in a population-based study of cognitively normal elderly.
abstract: OBJECTIVE
  Secondary prevention trials in subjects with preclinical Alzheimer disease may require documentation of brain amyloidosis. The identification of inexpensive and noninvasive screening variables that can identify individuals who have significant amyloid accumulation would reduce screening costs.
  
  
  METHODS
  A total of 483 cognitively normal (CN) individuals, aged 70-92 years, from the population-based Mayo Clinic Study of Aging, underwent Pittsburgh compound B (PiB)-PET imaging. Logistic regression determined whether age, sex, APOE genotype, family history, or cognitive performance was associated with odds of a PiB retention ratio >1.4 and >1.5. Area under the receiver operating characteristic curve (AUROC) evaluated the discrimination between PiB-positive and -negative subjects. For each characteristic, we determined the number needed to screen in each age group (70-79 and 80-89) to identify 100 participants with PiB >1.4 or >1.5.
  
  
  RESULTS
  A total of 211 (44%) individuals had PiB >1.4 and 151 (31%) >1.5. In univariate and multivariate models, discrimination was modest (AUROC ∼0.6-0.7). Multivariately, age and APOE best predicted odds of PiB >1.4 and >1.5. Subjective memory complaints were similar to cognitive test performance in predicting PiB >1.5. Indicators of PiB positivity varied with age. Screening APOE ε4 carriers alone reduced the number needed to screen to enroll 100 subjects with PIB >1.5 by 48% in persons aged 70-79 and 33% in those aged 80-89.
  
  
  CONCLUSIONS
  Age and APOE genotype are useful predictors of the likelihood of significant amyloid accumulation, but discrimination is modest. Nonetheless, these results suggest that inexpensive and noninvasive measures could significantly reduce the number of CN individuals needed to screen to enroll a given number of amyloid-positive subjects.
authors.affiliation: Division of Epidemiology, College of Medicine, Mayo Clinic, Rochester, MN, USA. mielke.michelle@mayo.edu
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Mielke
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Wiste
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Weigand
authors.forename: David S
authors.initials: DS
authors.lastname: Knopman
authors.forename: Val J
authors.initials: VJ
authors.lastname: Lowe
authors.forename: Rosebud O
authors.initials: RO
authors.lastname: Roberts
authors.forename: Yonas E
authors.initials: YE
authors.lastname: Geda
authors.forename: Dana M
authors.initials: DM
authors.lastname: Swenson-Dravis
authors.forename: Bradley F
authors.initials: BF
authors.lastname: Boeve
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Senjem
authors.forename: Prashanthi
authors.initials: P
authors.lastname: Vemuri
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Petersen
authors.forename: Clifford R
authors.initials: CR
authors.lastname: Jack
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000235:genetics; D000682:Amyloid / Q000378:metabolism*; D001057:Apolipoproteins E / Q000235:genetics; D001921:Brain / Q000000981:diagnostic imaging / Q000378:metabolism*; D001931:Brain Mapping; D003071:Cognition; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D011877:Radionuclide Imaging
chemical_list: D000682:Amyloid; D001057:Apolipoproteins E