J Korean Geriatr Psychiatry.  2016 Oct;20(2):68-74. 10.0000/jkgp.2016.20.2.68.

Distinct Clinical Characteristics Depending on Cerebral Amyloid Positivity in Patients with Alzheimer Disease Dementia

Affiliations
  • 1Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea. selfpsy@snu.ac.kr
  • 2Institute of Human Behavioral Medicine, Medical Research Center, Seoul National University, Seoul, Korea.
  • 3Department of Neuropsychiatry, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea.
  • 4Department of Neuropsychiatry, Changsan Convalescent Hospital, Changwon, Korea.
  • 5Department of Neuropsychiatry, Kyunggi Provincial Hospital for the Elderly, Yongin, Korea.
  • 6Department of Neuropsychiatry, SMG-SNU Boramae Medical Center, Seoul, Korea.
  • 7Department of Neuropsychiatry, Seoul National University College of Medicine, Seoul, Korea.
  • 8Department of Psychiatry, Inje University Sanggye Paik Hospital, Seoul, Korea.
  • 9Department of Nuclear Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea.
  • 10Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea.

Abstract


OBJECTIVE
The present study investigated the clinical characteristics of Alzheimer's disease (AD) dementia with low brain amyloid-beta (Aβ-AD) burden comparing with AD dementia with high amyloid-beta burden (Aβ+AD). We also developed a prediction model for the amyloid positivity on ¹¹C-labelled Pittsburgh Compound B (PiB) positron emission tomography (PET) with distinct clinical variables in AD dementia patients.
METHODS
Fifty-nine clinically defined AD dementia individuals, who participated in the Korean Brain Aging Study for Early diagnosis and prediction of AD (KBASE) study, were included. All the subjects received comprehensive clinical evaluations and PiB-PET. Based on cerebral PiB retention, all subjects were divided into Aβ+AD (n=47) and Aβ-AD (n=12) subgroups. To develop a prediction model for amyloid positivity, stepwise multiple logistic regression analysis was conducted.
RESULTS
When compared to Aβ+AD, Aβ-AD showed older age, later age-at-onset, and lower education. In regard of risk factors for dementia, Aβ-AD had higher frequency of hypertension and diabetes mellitus as well as lower frequency of apolipoprotein E (APOE) ε4 allele. Although there was no between group difference in Clinical Dementia Rating (CDR) or CDR sum-of-boxes scores, mini-mental state examination and constructional recall scores were higher for Aβ-AD than Aβ+AD. The final amyloid positivity prediction model included APOE4 genotype, hypertension, and diabetes mellitus.
CONCLUSION
The findings from this study indicated that clinically diagnosed AD dementia may have high possibility of not being pathological AD if they have older age and higher vascular risks, and did not have APOE4 genotype.

Keyword

Alzheimer dementia; Beta amyloid; Apolipoprotein E; Hypertension; Diabetes mellitus
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