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Prediction of dementia in MCI patients based on core diagnostic markers for Alzheimer disease.

Artikel i vetenskaplig tidskrift
Författare Annapaola Prestia
Anna Caroli
Wiesje M van der Flier
Rik Ossenkoppele
Bart Van Berckel
Frederik Barkhof
Charlotte E Teunissen
Anders E Wall
Stephen F Carter
Michael Schöll
Il Han Choo
Agneta Nordberg
Philip Scheltens
Giovanni B Frisoni
Publicerad i Neurology
Volym 80
Nummer/häfte 11
Sidor 1048-56
ISSN 1526-632X
Publiceringsår 2013
Publicerad vid
Sidor 1048-56
Språk en
Länkar dx.doi.org/10.1212/WNL.0b013e318287...
www.ncbi.nlm.nih.gov/entrez/query.f...
Ämnesord Aged, Aged, 80 and over, Alzheimer Disease, cerebrospinal fluid, diagnosis, pathology, Amyloid beta-Peptides, cerebrospinal fluid, Atrophy, Biomarkers, cerebrospinal fluid, Brain, pathology, Cognitive Dysfunction, cerebrospinal fluid, diagnosis, pathology, Dementia, diagnosis, pathology, Disease Progression, Female, Follow-Up Studies, Humans, Male, Middle Aged, Peptide Fragments, cerebrospinal fluid, Predictive Value of Tests, tau Proteins, cerebrospinal fluid
Ämneskategorier Medicinsk bioteknologi, Klinisk medicin

Sammanfattning

The current model of Alzheimer disease (AD) stipulates that brain amyloidosis biomarkers turn abnormal earliest, followed by cortical hypometabolism, and finally brain atrophy ones. The aim of this study is to provide clinical evidence of the model in patients with mild cognitive impairment (MCI).A total of 73 patients with MCI from 3 European memory clinics were included. Brain amyloidosis was assessed by CSF Aβ42 concentration, cortical metabolism by an index of temporoparietal hypometabolism on FDG-PET, and brain atrophy by automated hippocampal volume. Patients were divided into groups based on biomarker positivity: 1) Aβ42- FDG-PET- Hippo-, 2) Aβ42+ FDG-PET- Hippo-, 3) Aβ42 + FDG-PET + Hippo-, 4) Aβ42 + FDG-PET+ Hippo+, and 5) any other combination not in line with the model. Measures of validity were prevalence of group 5, increasing incidence of progression to dementia with increasing biological severity, and decreasing conversion time.When patients with MCI underwent clinical follow-up, 29 progressed to dementia, while 44 remained stable. A total of 26% of patients were in group 5. Incident dementia was increasing with greater biological severity in groups 1 to 5 from 4% to 27%, 64%, and 100% (p for trend < 0.0001), and occurred increasingly earlier (p for trend = 0.024).The core biomarker pattern is in line with the current pathophysiologic model of AD. Fully normal and fully abnormal pattern is associated with exceptional and universal development of dementia. Cases not in line might be due to atypical neurobiology or inaccurate thresholds for biomarker (ab)normality.

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