Abstract
ObjectiveThe multicenter prospective cohort study (Japan Cooperative SPECT Study on Assessment of Mild Impairment of Cognitive Function: J-COSMIC) aimed to examine the value of 123I-N-isopropyl-4-iodoamphetamine cerebral blood flow (IMP-CBF) SPECT in regards to early diagnosis of Alzheimer’s disease (AD) in patients with mild cognitive impairment (MCI).MethodsThree hundred and nineteen patients with amnestic MCI at 41 participating institutions each underwent clinical and neuropsychological examinations and 123I-IMP-CBF SPECT at baseline. Subjects were followed up periodically for 3 years, and progression to dementia was evaluated. SPECT images were classified as AD/DLB (dementia with Lewy bodies) pattern and non-AD/DLB pattern by central image interpretation and automated region of interest (ROI) analysis, respectively. Logistic regression analyses were used to assess whether baseline 123I-IMP-CBF SPECT was predictive of longitudinal clinical outcome.ResultsNinety-nine of 216 amnestic MCI patients (excluding 3 cases with epilepsy (n = 2) or hydrocephalus (n = 1) and 100 cases with incomplete follow-up) converted to AD within the observation period. Central image interpretation and automated ROI analysis predicted conversion to AD with 56 and 58 % overall diagnostic accuracy (sensitivity, 76 and 81 %; specificity, 39 and 37 %), respectively. Multivariate logistic regression analysis identified SPECT as a predictor, which distinguished AD converters from non-converters. The odds ratio for a positive SPECT to predict conversion to AD with automated ROI analysis was 2.5 and combining SPECT data with gender and mini-mental state examination (MMSE) further improved classification (joint odds ratio 20.08).Conclusions123I-IMP-CBF SPECT with both automated ROI analysis and central image interpretation was sensitive but relatively nonspecific for prediction of clinical outcome during the 3-year follow-up in individual amnestic MCI patients. A combination of statistically significant predictors, both SPECT with automated ROI analysis and neuropsychological evaluation, may increase predictive utility.Electronic supplementary materialThe online version of this article (doi:10.1007/s12149-013-0768-7) contains supplementary material, which is available to authorized users.
Highlights
Disease-modifying drugs such as vaccines and secretase inhibitors have been evaluated in clinical trials, Y
The objective of this study was to investigate the diagnostic value of 123I-iodoamphetamine cerebral blood flow (IMP-CBF) SPECT findings suggesting Alzheimer’s disease (AD)-like hypoperfusion in predicting mild cognitive impairment (MCI) conversion to AD based on a multicenter prospective study
As AD was the primary outcome of the study, these patients with non-AD dementia were excluded from further analyses
Summary
Disease-modifying drugs such as vaccines and secretase inhibitors have been evaluated in clinical trials, Y. MCI includes incipient AD and other causes of dementia, as well as a form of cognitive impairment that does not progress to dementia and may disappear This entity has been redefined to include amnestic MCI and non-amnestic MCI, according to the presence of an isolated objective memory deficit or of multiple or isolated extra-memory cognitive impairments [5]. This variation in MCI has been evaluated using neuropsychological tests, neuroimaging, and biologic markers. Data from both clinical and 123IIMP-CBF SPECT assessments within a large multicenter prospective cohort study of subjects with amnestic MCI (Japan Cooperative SPECT Study on Assessment of Mild Impairment of Cognitive Function: J-COSMIC) are reported. The objective of this study was to investigate the diagnostic value of 123I-IMP-CBF SPECT findings suggesting AD-like hypoperfusion in predicting MCI conversion to AD based on a multicenter prospective study
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