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Mild cognitive impairment with suspected nonamyloid pathology (SNAP) Prediction of progression

Journal article
Authors A. Caroli
A. Prestia
S. Galluzzi
C. Ferrari
W. M. van der Flier
R. Ossenkoppele
B. Van Berckel
F. Barkhof
C. Teunissen
A. E. Wall
S. F. Carter
Michael Schöll
I. H. Choo
T. Grimmer
A. Redolfi
A. Nordberg
P. Scheltens
A. Drzezga
G. B. Frisoni
Published in Neurology
Volume 84
Issue 5
Pages 508-515
ISSN 0028-3878
Publication year 2015
Published at Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation
Pages 508-515
Language en
Links dx.doi.org/10.1212/wnl.000000000000...
Keywords CEREBROSPINAL-FLUID BIOMARKERS, ALZHEIMERS-DISEASE, NATIONAL INSTITUTE, BETA, DEMENTIA, AD, RECOMMENDATIONS, ACCURACY, MARKERS, TANGLE, Clinical Neurology
Subject categories Neurosciences

Abstract

Objectives:The aim of this study was to investigate predictors of progressive cognitive deterioration in patients with suspected non-Alzheimer disease pathology (SNAP) and mild cognitive impairment (MCI).Methods:We measured markers of amyloid pathology (CSF -amyloid 42) and neurodegeneration (hippocampal volume on MRI and cortical metabolism on [F-18]-fluorodeoxyglucose-PET) in 201 patients with MCI clinically followed for up to 6 years to detect progressive cognitive deterioration. We categorized patients with MCI as A+/A- and N+/N- based on presence/absence of amyloid pathology and neurodegeneration. SNAPs were A-N+ cases.Results:The proportion of progressors was 11% (8/41), 34% (14/41), 56% (19/34), and 71% (60/85) in A-N-, A+N-, SNAP, and A+N+, respectively; the proportion of APOE epsilon 4 carriers was 29%, 70%, 31%, and 71%, respectively, with the SNAP group featuring a significantly different proportion than both A+N- and A+N+ groups (p 0.005). Hypometabolism in SNAP patients was comparable to A+N+ patients (p = 0.154), while hippocampal atrophy was more severe in SNAP patients (p = 0.002). Compared with A-N-, SNAP and A+N+ patients had significant risk of progressive cognitive deterioration (hazard ratio = 2.7 and 3.8, p = 0.016 and p < 0.001), while A+N- patients did not (hazard ratio = 1.13, p = 0.771). In A+N- and A+N+ groups, none of the biomarkers predicted time to progression. In the SNAP group, lower time to progression was correlated with greater hypometabolism (r = 0.42, p = 0.073).Conclusions:Our findings support the notion that patients with SNAP MCI feature a specific risk progression profile.

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