title: 18F-FDG-PET correlates of cognitive impairment in ALS.
abstract: OBJECTIVE
  To identify the metabolic signature of the various levels of cognitive deficits in amyotrophic lateral sclerosis (ALS) using 18F-2-fluoro-2-deoxy-d-glucose-PET (18F-FDG-PET).
  
  
  METHODS
  A total of 170 ALS cases consecutively enrolled at the ALS Center of Turin underwent brain 18F-FDG-PET and were classified as displaying normal cognition (ALS-Cn; n = 94), full-blown frontotemporal dementia (ALS-FTD; n = 20), executive or nonexecutive cognitive impairment not fulfilling FTD criteria (ALS-Ci; n = 37), prevalent behavioral changes (n = 9), or nonclassifiable impairment (n = 10) according to neuropsychological testing. Group comparisons of 18F-FDG-PET pattern were carried out among the cognitive subgroups.
  
  
  RESULTS
  We found a significantly reduced frontal and prefrontal metabolism in ALS-FTD as compared to ALS-Cn, while ALS-Ci showed an intermediate metabolic behavior in frontal cortex, being hypometabolic as compared to ALS-Cn, and relatively hypermetabolic as compared to ALS-FTD. Hypometabolism in frontal regions was associated in all comparisons to hypermetabolism in cerebellum, midbrain, and corticospinal tracts: the more severe the cognitive decline, the larger the size of the cluster and the statistical significance of 18F-FDG uptake differences.
  
  
  CONCLUSIONS
  This study demonstrated in a large cohort of patients with ALS a continuum of frontal lobe metabolic impairment reflecting the clinical and anatomic continuum ranging from pure ALS, through ALS with intermediate cognitive deficits, to ALS-FTD, and showing that patients with intermediate cognitive impairment display a characteristic metabolic pattern. Since 18F-FDG-PET allows us to estimate the cerebral lesion load in vivo in neurodegenerative diseases, it might be helpful to investigate in ALS its association with neuropsychological testing along the disease course to disclose the early metabolic signature of possible cognitive impairment.
authors.affiliation: From the ALS Center (A. Canosa, A.M., B.I., S.C., A.I., C.M., A. Calvo, A. Chiò), "Rita Levi Montalcini" Department of Neuroscience, University of Turin; Department of Neurosciences, Ophthalmology, Genetics, Rehabilitation and Child Health (A. Canosa), University of Genoa; Institute of Cognitive Sciences and Technologies (M.P., A. Cistaro, A. Chiò), C.N.R., Rome, Italy; Department of Nuclear Medicine (M.P.), Karolinska Hospital, Stockholm, Sweden; Positron Emission Tomography Centre IRMET S.p.A. (A. Cistaro, P.F.), EuroMedic International, Turin; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino (A. Calvo, A. Chiò), Turin; and the Neuroscience Institute of Turin (NIT) (A. Calvo, A. Chiò), Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Canosa
authors.affiliation: From the ALS Center (A. Canosa, A.M., B.I., S.C., A.I., C.M., A. Calvo, A. Chiò), "Rita Levi Montalcini" Department of Neuroscience, University of Turin; Department of Neurosciences, Ophthalmology, Genetics, Rehabilitation and Child Health (A. Canosa), University of Genoa; Institute of Cognitive Sciences and Technologies (M.P., A. Cistaro, A. Chiò), C.N.R., Rome, Italy; Department of Nuclear Medicine (M.P.), Karolinska Hospital, Stockholm, Sweden; Positron Emission Tomography Centre IRMET S.p.A. (A. Cistaro, P.F.), EuroMedic International, Turin; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino (A. Calvo, A. Chiò), Turin; and the Neuroscience Institute of Turin (NIT) (A. Calvo, A. Chiò), Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Pagani
authors.affiliation: From the ALS Center (A. Canosa, A.M., B.I., S.C., A.I., C.M., A. Calvo, A. Chiò), "Rita Levi Montalcini" Department of Neuroscience, University of Turin; Department of Neurosciences, Ophthalmology, Genetics, Rehabilitation and Child Health (A. Canosa), University of Genoa; Institute of Cognitive Sciences and Technologies (M.P., A. Cistaro, A. Chiò), C.N.R., Rome, Italy; Department of Nuclear Medicine (M.P.), Karolinska Hospital, Stockholm, Sweden; Positron Emission Tomography Centre IRMET S.p.A. (A. Cistaro, P.F.), EuroMedic International, Turin; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino (A. Calvo, A. Chiò), Turin; and the Neuroscience Institute of Turin (NIT) (A. Calvo, A. Chiò), Italy.
authors.forename: Angelina
authors.initials: A
authors.lastname: Cistaro
authors.affiliation: From the ALS Center (A. Canosa, A.M., B.I., S.C., A.I., C.M., A. Calvo, A. Chiò), "Rita Levi Montalcini" Department of Neuroscience, University of Turin; Department of Neurosciences, Ophthalmology, Genetics, Rehabilitation and Child Health (A. Canosa), University of Genoa; Institute of Cognitive Sciences and Technologies (M.P., A. Cistaro, A. Chiò), C.N.R., Rome, Italy; Department of Nuclear Medicine (M.P.), Karolinska Hospital, Stockholm, Sweden; Positron Emission Tomography Centre IRMET S.p.A. (A. Cistaro, P.F.), EuroMedic International, Turin; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino (A. Calvo, A. Chiò), Turin; and the Neuroscience Institute of Turin (NIT) (A. Calvo, A. Chiò), Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Montuschi
authors.affiliation: From the ALS Center (A. Canosa, A.M., B.I., S.C., A.I., C.M., A. Calvo, A. Chiò), "Rita Levi Montalcini" Department of Neuroscience, University of Turin; Department of Neurosciences, Ophthalmology, Genetics, Rehabilitation and Child Health (A. Canosa), University of Genoa; Institute of Cognitive Sciences and Technologies (M.P., A. Cistaro, A. Chiò), C.N.R., Rome, Italy; Department of Nuclear Medicine (M.P.), Karolinska Hospital, Stockholm, Sweden; Positron Emission Tomography Centre IRMET S.p.A. (A. Cistaro, P.F.), EuroMedic International, Turin; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino (A. Calvo, A. Chiò), Turin; and the Neuroscience Institute of Turin (NIT) (A. Calvo, A. Chiò), Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Iazzolino
authors.affiliation: From the ALS Center (A. Canosa, A.M., B.I., S.C., A.I., C.M., A. Calvo, A. Chiò), "Rita Levi Montalcini" Department of Neuroscience, University of Turin; Department of Neurosciences, Ophthalmology, Genetics, Rehabilitation and Child Health (A. Canosa), University of Genoa; Institute of Cognitive Sciences and Technologies (M.P., A. Cistaro, A. Chiò), C.N.R., Rome, Italy; Department of Nuclear Medicine (M.P.), Karolinska Hospital, Stockholm, Sweden; Positron Emission Tomography Centre IRMET S.p.A. (A. Cistaro, P.F.), EuroMedic International, Turin; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino (A. Calvo, A. Chiò), Turin; and the Neuroscience Institute of Turin (NIT) (A. Calvo, A. Chiò), Italy.
authors.forename: Piercarlo
authors.initials: P
authors.lastname: Fania
authors.affiliation: From the ALS Center (A. Canosa, A.M., B.I., S.C., A.I., C.M., A. Calvo, A. Chiò), "Rita Levi Montalcini" Department of Neuroscience, University of Turin; Department of Neurosciences, Ophthalmology, Genetics, Rehabilitation and Child Health (A. Canosa), University of Genoa; Institute of Cognitive Sciences and Technologies (M.P., A. Cistaro, A. Chiò), C.N.R., Rome, Italy; Department of Nuclear Medicine (M.P.), Karolinska Hospital, Stockholm, Sweden; Positron Emission Tomography Centre IRMET S.p.A. (A. Cistaro, P.F.), EuroMedic International, Turin; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino (A. Calvo, A. Chiò), Turin; and the Neuroscience Institute of Turin (NIT) (A. Calvo, A. Chiò), Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Cammarosano
authors.affiliation: From the ALS Center (A. Canosa, A.M., B.I., S.C., A.I., C.M., A. Calvo, A. Chiò), "Rita Levi Montalcini" Department of Neuroscience, University of Turin; Department of Neurosciences, Ophthalmology, Genetics, Rehabilitation and Child Health (A. Canosa), University of Genoa; Institute of Cognitive Sciences and Technologies (M.P., A. Cistaro, A. Chiò), C.N.R., Rome, Italy; Department of Nuclear Medicine (M.P.), Karolinska Hospital, Stockholm, Sweden; Positron Emission Tomography Centre IRMET S.p.A. (A. Cistaro, P.F.), EuroMedic International, Turin; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino (A. Calvo, A. Chiò), Turin; and the Neuroscience Institute of Turin (NIT) (A. Calvo, A. Chiò), Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Ilardi
authors.affiliation: From the ALS Center (A. Canosa, A.M., B.I., S.C., A.I., C.M., A. Calvo, A. Chiò), "Rita Levi Montalcini" Department of Neuroscience, University of Turin; Department of Neurosciences, Ophthalmology, Genetics, Rehabilitation and Child Health (A. Canosa), University of Genoa; Institute of Cognitive Sciences and Technologies (M.P., A. Cistaro, A. Chiò), C.N.R., Rome, Italy; Department of Nuclear Medicine (M.P.), Karolinska Hospital, Stockholm, Sweden; Positron Emission Tomography Centre IRMET S.p.A. (A. Cistaro, P.F.), EuroMedic International, Turin; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino (A. Calvo, A. Chiò), Turin; and the Neuroscience Institute of Turin (NIT) (A. Calvo, A. Chiò), Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Moglia
authors.affiliation: From the ALS Center (A. Canosa, A.M., B.I., S.C., A.I., C.M., A. Calvo, A. Chiò), "Rita Levi Montalcini" Department of Neuroscience, University of Turin; Department of Neurosciences, Ophthalmology, Genetics, Rehabilitation and Child Health (A. Canosa), University of Genoa; Institute of Cognitive Sciences and Technologies (M.P., A. Cistaro, A. Chiò), C.N.R., Rome, Italy; Department of Nuclear Medicine (M.P.), Karolinska Hospital, Stockholm, Sweden; Positron Emission Tomography Centre IRMET S.p.A. (A. Cistaro, P.F.), EuroMedic International, Turin; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino (A. Calvo, A. Chiò), Turin; and the Neuroscience Institute of Turin (NIT) (A. Calvo, A. Chiò), Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Calvo
authors.affiliation: From the ALS Center (A. Canosa, A.M., B.I., S.C., A.I., C.M., A. Calvo, A. Chiò), "Rita Levi Montalcini" Department of Neuroscience, University of Turin; Department of Neurosciences, Ophthalmology, Genetics, Rehabilitation and Child Health (A. Canosa), University of Genoa; Institute of Cognitive Sciences and Technologies (M.P., A. Cistaro, A. Chiò), C.N.R., Rome, Italy; Department of Nuclear Medicine (M.P.), Karolinska Hospital, Stockholm, Sweden; Positron Emission Tomography Centre IRMET S.p.A. (A. Cistaro, P.F.), EuroMedic International, Turin; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino (A. Calvo, A. Chiò), Turin; and the Neuroscience Institute of Turin (NIT) (A. Calvo, A. Chiò), Italy. achio@usa.net.
authors.forename: Adriano
authors.initials: A
authors.lastname: Chiò
mesh_terms: D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000523:psychology*; D003072:Cognition Disorders / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000523:psychology*; D015331:Cohort Studies; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D049268:Positron-Emission Tomography
chemical_list: D019788:Fluorodeoxyglucose F18