Silva-Rodriguez, Jesus;
Labrador-Espinosa, Miguel A;
Moscoso, Alexis;
Scholl, Michael;
Mir, Pablo;
Grothe, Michel;
(2022)
Differential effects of tau stage, Lewy body pathology, and substantia nigra degeneration on FDG-PET patterns in clinical AD.
Journal of Nuclear Medicine
10.2967/jnumed.122.264213.
(In press).
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Abstract
PURPOSE: Comorbid Lewy body (LB) pathology is common in AD. The effect of LB co-pathology on FDG-PET patterns in AD is yet to be studied. We analysed associations of neuropathologically-assessed tau pathology, LB pathology, and substantia nigra neuron loss (SNnl) with ante-mortem FDG-PET hypometabolism in patients with a clinical AD presentation. METHODS: Twenty-one patients with autopsy-confirmed AD (‘pure-AD’), 24 with AD and LB co-pathology (‘AD-LB’), and 7 with LB but no or low evidence of AD pathology (‘pure-LB’) were studied. Pathologic groups were compared on regional and voxel-wise FDG-PET patterns, the cingulate island sign ratio (CISr), and neuropathological ratings of SNnl. Additional analyses assessed continuous associations of Braak tangle stage and SNnl with FDG-PET patterns. RESULTS: Pure-AD and AD-LB showed highly similar patterns of AD-typical temporo-parietal hypometabolism and did not differ in CISr, regional FDG SUVR, or SNnl. By contrast, pure-LB showed the expected DLB-like pattern, accompanied by pronounced occipital hypometabolism and elevated CISr and SNnl compared to the AD groups. In continuous analyses, Braak tangle stage was significantly correlated with more AD-like, and SNnl with more DLB-like, FDG-PET patterns. CONCLUSIONS: In autopsy-confirmed AD dementia patients, comorbid LB pathology did not have a notable effect on the regional FDG-PET pattern. A more DLB-like FDG-PET pattern was observed in relation to SNnl, but advanced SNnl was mostly limited to relatively pure LB cases. AD pathology may have a dominant effect over LB pathology in determining the regional neurodegeneration phenotype.
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