Poster 34: Evidence-Based Practice for Early Cognitive Impairment Detection on Older Individuals with Metabolic Syndrome

Abstract

Background: Alzheimer's disease (AD) is the most common form of dementia, and it has been associated to diabetes and metabolic syndrome. Due to the high prevalence of diabetes and metabolic syndrome in the older population, it is important to detect cognitive decline at early stages to allow prompt initiation of therapy and counseling of the patients and family. Objective: The objective of this study is twofold: 1) to systematically analyze the literature to investigate the clinical significance of FDG-PET in the early diagnosis of mild cognitive impairment (MCI), and 2) based on the systematic review, we examine by a case study design the patterns of hypometabolism found in 2 older female subjects with metabolic syndrome and subjective memory complaints. Systematic Review Methods: An extensive review of literature has been conducted, using PubMed as the primary search engine. A set of predefined inclusion criteria was used to determine inclusion and analysis of the papers. Systematic Review Results: A total of 6 studies were included in the review. Cognitive decline was predicted with sensitivities ranging from 38% to 93%, specificities ranging from 62.5% to 97% and accuracies from 81.8 to 90% (N=6). Case Study Methods: Two older female patients (P1& P2) were evaluated by a comprehensive battery of neurological, memory, and laboratory tests. Case Study Results: Both patients had insulin resistance and MS. The neuropsychological evaluation indicated that both patients suffer from mild MCI. Conclusions: The results of the review of literature show that due to the high values for specificity, sensitivity, and accuracy, as well as due to the consistent patterns of hypometabolism detected, FDG-PET is a good diagnostic tool and shows great promise as a clinical tool in the early detection of MCI. As for the case study, the FDG-PET scans of P1 and P2 showed different patterns of hypometabolism, suggesting the patients have two different types of MCI. Even though most of the neuropsychological tests were close to normal ranges, the PET scan was able to detect patterns of hypometabolism—and thus reduced function, consistent with the subjective memory complaints of the patients. The objective assessment performed with FDG-PET was more reliable in predicting early MCI than the neuropsychological tests, as suggested by previous studies.