Positron Emission Tomography in Evaluation of Dementia: Regional Brain Metabolism and Long-term Outcome

CONTEXT Deficits in cerebral glucose utilization have been identified in patients with cognitive dysfunction attributed to various disease processes, but their prognostic and diagnostic value remains to be defined. OBJECTIVE To assess the sensitivity and specificity with which cerebral metabolic pat...

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Published in:	JAMA : the journal of the American Medical Association Vol. 286; no. 17; pp. 2120 - 2127
Main Authors:	Silverman, Daniel H. S, Small, Gary W, Chang, Carol Y, Lu, Carolyn S, de Aburto, Michelle A. Kung, Chen, Wei, Czernin, Johannes, Rapoport, Stanley I, Pietrini, Pietro, Alexander, Gene E, Schapiro, Mark B, Jagust, William J, Hoffman, John M, Welsh-Bohmer, Kathleen A, Alavi, Abass, Clark, Christopher M, Salmon, Eric, de Leon, Mony J, Mielke, Ruediger, Cummings, Jeffrey L, Kowell, Arthur P, Gambhir, Sanjiv S, Hoh, Carl K, Phelps, Michael E
Format:	Journal Article
Language:	English
Published:	Chicago, IL American Medical Association 07-11-2001
Subjects:	Aged Alzheimer's disease Biological and medical sciences Brain Brain - diagnostic imaging Brain - metabolism Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases Dementia Dementia - diagnosis Dementia - diagnostic imaging Dementia - physiopathology Disease Progression Female Fluorodeoxyglucose F18 Glucose - metabolism Humans Likelihood Functions Male Medical sciences Metabolism Middle Aged Neurology Predictive Value of Tests Prognosis Radiopharmaceuticals Sensitivity and Specificity Studies Tomography, Emission-Computed Human Evaluation Nervous system diseases Prognosis Radiodiagnosis Exploration Metabolism Long term Cerebral disorder Central nervous system disease Degenerative disease Positron emission tomography Dementia
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Summary:	CONTEXT Deficits in cerebral glucose utilization have been identified in patients with cognitive dysfunction attributed to various disease processes, but their prognostic and diagnostic value remains to be defined. OBJECTIVE To assess the sensitivity and specificity with which cerebral metabolic patterns at a single point in time forecast subsequent documentation of progressive dementia. DESIGN, SETTING, AND PATIENTS Positron emission tomography (PET) studies of [18F]fluorodeoxyglucose in 146 patients undergoing evaluation for dementia with at least 2 years' follow-up for disease progression at the University of California, Los Angeles, from 1991 to 2000, and PET studies in 138 patients undergoing evaluation for dementia at an international consortium of facilities, with histopathological diagnoses an average of 2.9 years later, conducted from 1984 to 2000. MAIN OUTCOME MEASURES Regional distribution of [18F]fluorodeoxyglucose in each patient, classified by criteria established a priori as positive or negative for presence of a progressive neurodegenerative disease in general and of Alzheimer disease (AD) specifically, compared with results of longitudinal or neuropathologic analyses. RESULTS Progressive dementia was detected by PET with a sensitivity of 93% (191/206) and a specificity of 76% (59/78). Among patients with neuropathologically based diagnoses, PET identified patients with AD and patients with any neurodegenerative disease with a sensitivity of 94% and specificities of 73% and 78%, respectively. The negative likelihood ratio of experiencing a progressive vs nonprogressive course over the several years following a single negative brain PET scan was 0.10 (95% confidence interval, 0.06-0.16), and the initial pattern of cerebral metabolism was significantly associated with the subsequent course of progression overall (P<.001). CONCLUSION In patients presenting with cognitive symptoms of dementia, regional brain metabolism was a sensitive indicator of AD and of neurodegenerative disease in general. A negative PET scan indicated that pathologic progression of cognitive impairment during the mean 3-year follow-up was unlikely to occur.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-Article-1 ObjectType-Feature-2
ISSN:	0098-7484 1538-3598
DOI:	10.1001/jama.286.17.2120