title: Combination of Structural MRI and FDG-PET of the Brain Improves Diagnostic Accuracy in Newly Manifested Cognitive Impairment in Geriatric Inpatients.
abstract: The cause of cognitive impairment in acutely hospitalized geriatric patients is often unclear. The diagnostic process is challenging but important in order to treat potentially life-threatening etiologies or identify underlying neurodegenerative disease.
  
  
  
  To evaluate the add-on diagnostic value of structural and metabolic neuroimaging in newly manifested cognitive impairment in elderly geriatric inpatients.
  
  
  
  Eighty-one inpatients (55 females, 81.6±5.5 y) without history of cognitive complaints prior to hospitalization were recruited in 10 acute geriatrics clinics. Primary inclusion criterion was a clinical hypothesis of Alzheimer's disease (AD), cerebrovascular disease (CVD), or mixed AD+CVD etiology (MD), which remained uncertain after standard diagnostic workup. Additional procedures performed after enrollment included detailed neuropsychological testing and structural MRI and FDG-PET of the brain. An interdisciplinary expert team established the most probable etiologic diagnosis (non-neurodegenerative, AD, CVD, or MD) integrating all available data. Automatic multimodal classification based on Random Undersampling Boosting was used for rater-independent assessment of the complementary contribution of the additional diagnostic procedures to the etiologic diagnosis.
  
  
  
  Automatic 4-class classification based on all diagnostic routine standard procedures combined reproduced the etiologic expert diagnosis in 31% of the patients (p = 0.100, chance level 25%). Highest accuracy by a single modality was achieved by MRI or FDG-PET (both 45%, p≤0.001). Integration of all modalities resulted in 76% accuracy (p≤0.001).
  
  
  
  These results indicate substantial improvement of diagnostic accuracy in uncertain de novo cognitive impairment in acutely hospitalized geriatric patients with the integration of structural MRI and brain FDG-PET into the diagnostic process.
authors: Berlin Center for Advanced Neuroimaging, Bernstein Center for Computational Neuroscience, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors: Kerstin
authors: K
authors: Ritter
authors: Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors: Catharina
authors: C
authors: Lange
authors: Berlin Center for Advanced Neuroimaging, Bernstein Center for Computational Neuroscience, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors: Martin
authors: M
authors: Weygandt
authors: Evangelisches Geriatriezentrum Berlin, Berlin, Germany.
authors: Anja
authors: A
authors: Mäurer
authors: Evangelisches Geriatriezentrum Berlin, Berlin, Germany.
authors: Anna
authors: A
authors: Roberts
authors: Geriatric Research Group, Department of Geriatric Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors: Melanie
authors: M
authors: Estrella
authors: Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.|Jung Diagnostics GmbH, Hamburg, Germany.
authors: Per
authors: P
authors: Suppa
authors: Jung Diagnostics GmbH, Hamburg, Germany.
authors: Lothar
authors: L
authors: Spies
authors: Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors: Vikas
authors: V
authors: Prasad
authors: Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors: Ingo
authors: I
authors: Steffen
authors: Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany.
authors: Ivayla
authors: I
authors: Apostolova
authors: Department of Neurology, University Hospital Magdeburg, Magdeburg, Germany.
authors: Daniel
authors: D
authors: Bittner
authors: Geriatric Research Group, Department of Geriatric Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors: Mehmet
authors: M
authors: Gövercin
authors: Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors: Winfried
authors: W
authors: Brenner
authors: Vivantes Ida Wolff Krankenhaus, Berlin, Germany.
authors: Christine
authors: C
authors: Mende
authors: Department of Psychiatry and Psychotherapy Charité Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors: Oliver
authors: O
authors: Peters
authors: Evangelisches Geriatriezentrum Berlin, Berlin, Germany.|Department of Internal Medicine/Infectious Diseases and Pulmonary Medicine, Charité - Universitätsmedizin Berlin, Germany.
authors: Joachim
authors: J
authors: Seybold
authors: Center for Stroke Research Berlin, Charité, Berlin, Germany.
authors: Jochen B
authors: JB
authors: Fiebach
authors: Lipid Clinic at the Interdisciplinary Metabolism Center, Charité - Universitätsmedizin, Berlin, Germany.
authors: Elisabeth
authors: E
authors: Steinhagen-Thiessen
authors: AXA Research Fund & UPMC Chair, Sorbonne Universités, Université Pierre et Marie Curie, Paris 06, Institut de la Mémoire et de la Maladied' Alzheimer (IM2A) & Institut du Cerveau et de la Moelleépinière (ICM), Département de Neurologie, Hôpital de la Pitié-Salpêtrière, Paris, France.
authors: Harald
authors: H
authors: Hampel
authors: Berlin Center for Advanced Neuroimaging, Bernstein Center for Computational Neuroscience, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors: John-Dylan
authors: JD
authors: Haynes
authors: Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors: Ralph
authors: R
authors: Buchert
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging*; D060825:Cognitive Dysfunction / Q000000981:diagnostic imaging* / Q000523:psychology; D005260:Female; D019788:Fluorodeoxyglucose F18; D015577:Geriatric Assessment / Q000379:methods*; D006299:Health Services for the Aged; D006801:Humans; D007297:Inpatients / Q000523:psychology; D008279:Magnetic Resonance Imaging; D008297:Male; D049268:Positron-Emission Tomography; D011446:Prospective Studies
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: Cognitive impairment; geriatric inpatients; magnetic resonance imaging; multimodal classification; positron emission tomography