O1-01-05: [18F]FLUTEMETAMOL AMYLOID PET IN SYMPTOMATIC ALZHEIMER'S DISEASE (AD) AND PATHOLOGICALLY PRECLINICAL AD (P-PREAD) IN COMPARISON TO NON-AD CONTROLS: IMPACT OF CEREBRAL AMYLOID ANGIOPATHY

Objective:To determine the contribution of cerebral amyloid angiopathy (CAA) to Pittsburgh compound B (PiB)-PET tracer retention.Methods:Participants from the Mayo Clinic Study of Aging and Mayo Clinic Alzheimer’s Disease Research Center with antemortem PiB-PET imaging for amyloid beta (Aβ) and later underwent autopsy were included in this study. Pathologic regional leptomeningeal, parenchymal, capillary CAA, and Aβ plaque burden were calculated from one hemisphere. Regional lobar amyloid SUVr on PET was calculated from the same hemisphere sampled at autopsy. Single- and multiple-predictor linear-regression models were used to evaluate the relative contributions of pathologically determined regional CAA and Aβ plaques to antemortem PiB-PET SUVr.Results:Forty-one participants (30 male, 11 female) with a mean age at death of 75.7 (10.6) years were included. Twenty-seven (66%) had high PiB signal with a mean of 2.3 (1.2) years from time of PET scan to death; twenty-four (59%) had a pathologic diagnosis of Alzheimer’s disease. On multivariate analysis, CAA was not associated with PiB-PET SUVr while plaques remained associated with PiB-PET SUVr in all regions (all p <0.05). In patients without frequent amyloid plaques, CAA was not associated with PiB-PET in any region.Conclusion:We did not find evidence that pathologically-confirmed regional CAA burden contributes significantly to proximal antemortem regional PiB-PET signal, suggesting that amyloid PET imaging for measurement of cortical amyloid burden is unconfounded by CAA on a lobar level. Whether CAA burden contributes to PiB-PET signal in patients with severe CAA phenotypes, such as lobar hemorrhage, requires further investigation.

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Amyloid-PET burden and regional distribution in cerebral amyloid angiopathy: a systematic review and meta-analysis of biomarker performance

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2017-316851 ◽

2017 ◽

Vol 89 (4) ◽

pp. 410-417 ◽

Cited By ~ 15

Author(s):

Andreas Charidimou ◽

Karim Farid ◽

Hsin-Hsi Tsai ◽

Li-Kai Tsai ◽

Rouh-Fang Yen ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Cerebral Amyloid Angiopathy ◽

Intracerebral Haemorrhage ◽

Meta Analysis ◽

Amyloid Angiopathy ◽

Amyloid Pet ◽

Uptake Ratio ◽

Comparison Groups ◽

Cerebral Amyloid

IntroductionWe performed a meta-analysis to synthesise current evidence on amyloid-positron emission tomography (PET) burden and presumed preferential occipital distribution in sporadic cerebral amyloid angiopathy (CAA).MethodsIn a PubMed systematic search, we identified case–control studies with extractable data on global and occipital-to-global amyloid-PET uptake in symptomatic patients with CAA (per Boston criteria) versus control groups (healthy participants or patients with non-CAA deep intracerebral haemorrhage) and patients with Alzheimer’s disease. To circumvent PET studies’ methodological variation, we generated and used ‘fold change’, that is, ratio of mean amyloid uptake (global and occipital-to-global) of CAA relative to comparison groups. Amyloid-PET uptake biomarker performance was then quantified by random-effects meta-analysis on the ratios of the means. A ratio >1 indicates that amyloid-PET uptake (global or occipital/global) is higher in CAA than comparison groups, and a ratio <1 indicates the reverse.ResultsSeven studies, including 106 patients with CAA (>90% with probable CAA) and 138 controls (96 healthy elderly, 42 deep intracerebral haemorrhage controls) and 72 patients with Alzheimer’s disease, were included. Global amyloid-PET ratio between patients with CAA and controls was above 1, with an average effect size of 1.18 (95% CI 1.08 to 1.28; p<0.0001). Occipital-to-global amyloid-PET uptake ratio did not differ between patients with CAA versus patients with deep intracerebral haemorrhage or healthy controls. By contrast, occipital-to-global amyloid-PET uptake ratio was above 1 in patients with CAA versus those with Alzheimer’s disease, with an average ratio of 1.10 (95% CI 1.03 to 1.19; p=0.009) and high statistical heterogeneity.ConclusionsOur analysis provides exploratory actionable data on the overall effect sizes and strength of amyloid-PET burden and distribution in patients with CAA, useful for future larger studies.

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Relationship of neurofibrillary pathology to cerebral amyloid angiopathy in Alzheimer's disease

Neuropathology and Applied Neurobiology ◽

10.1111/j.1365-2990.2005.00663.x ◽

2005 ◽

Vol 31 (4) ◽

pp. 414-421 ◽

Cited By ~ 27

Author(s):

S. Williams ◽

K. Chalmers ◽

G. K. Wilcock ◽

S. Love

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Cerebral Amyloid Angiopathy ◽

Amyloid Angiopathy ◽

Neurofibrillary Pathology ◽

Cerebral Amyloid ◽

Relationship Of

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[ 18 F]FDG PET may differentiate cerebral amyloid angiopathy from Alzheimer’s disease

European Journal of Neurology ◽

10.1111/ene.14743 ◽

2021 ◽

Author(s):

Sébastien Bergeret ◽

Mathieu Queneau ◽

Mathieu Rodallec ◽

Emmanuel Curis ◽

Julien Dumurgier ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Cerebral Amyloid Angiopathy ◽

Fdg Pet ◽

Amyloid Angiopathy ◽

Cerebral Amyloid

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Abstract P418: Stroke Admissions and Outcomes Among Cerebral Amyloid Angiopathy and Alzheimer’s Disease in the National Inpatient Sample

Stroke ◽

10.1161/str.52.suppl_1.p418 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Nandakumar Nagaraja ◽

Urvish K Patel

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Hospital Mortality ◽

Cerebral Amyloid Angiopathy ◽

Amyloid Angiopathy ◽

Secondary Diagnosis ◽

National Inpatient Sample ◽

Admission Rates ◽

Secondary Outcomes ◽

Cerebral Amyloid

Background/Purpose: Although cerebral amyloid angiopathy (CAA) and Alzheimer’s Disease (AD) can manifest as separate diseases it can co-exist due to shared amyloid β pathogenic mechanisms. We assessed admission rates and outcomes of ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) among hospitalized patients with a secondary diagnosis of AD and CAA. Methods: Adult patients discharged with a secondary diagnosis of CAA or AD in National Inpatient Sample (NIS) in the years 2016 and 2017 were identified. Admission rates for IS, ICH, and SAH were primary outcomes. In-hospital mortality and discharge to home were secondary outcomes. Multivariate logistic regression analysis was performed to evaluate secondary outcomes with model adjusted for demographics, medical history, hospital characteristics, and Elixhauser comorbidity index. Results: Among 60,609,519 admissions in NIS, 893,834 (1.5%) patients had a secondary diagnosis of AD [mean age 82.1 years and 62% women] and 14,850 (0.02%) patients had CAA [mean age 76.2 years and 51% women]. Combined AD+CAA was present in 1,335 (0.002%) patients. Compared to AD and controls (non AD or CAA), patients with CAA had higher admission rates for IS (11.5% CAA vs 2.8% AD vs 1.7% control, p<0.0001), for ICH (29.5% CAA vs 0.4% AD vs 0.2% control, p<0.0001) and for SAH (3% CAA vs 0.1% AD vs 0.1% control, p<0.0001). Among patients admitted for IS, discharge to home was less likely in AD compared to controls (10.4% AD vs 36.3% control, OR=0.40; 95%CI=0.36-0.44). Among patients admitted for ICH, discharge to home was less likely in AD compared to controls (6.3% AD vs 18.5% control, OR=0.57; 95%CI=0.41-0.78) but higher in CAA (17.8% CAA vs 18.5% control, OR=1.35; 95%CI=1.11-1.63). In-hospital mortality was less likely in patients with CAA than controls among patients admitted for ICH (9.6% CAA vs 23% control, OR=0.33; 95%CI=0.26-0.41) and SAH (6.7% CAA vs 19.1% control, OR=0.27; 95%CI=0.11-0.62). Conclusion: Admissions for IS, ICH, and SAH were higher among CAA compared to AD in NIS. CAA patients had lower in-hospital mortality for ICH and SAH admissions and higher rates of home discharge for ICH admissions. AD patients were less likely to be discharged home for IS and ICH admissions.

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