Prevalence of Amyloid PET Positivity in Dementia Syndromes

By Rik Ossenkoppele, Willemijn J. Jansen, Gil D. Rabinovici, Dirk L. Knol, W. M. van der Flier, B. V. van Berckel, Philip Scheltens, Pieter Jelle Visser. Journal of the American Medical Association (JAMA), 2015

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IMPORTANCE Amyloid-β positron emission tomography (PET) imaging allows in vivo detection of fibrillar plaques, a core neuropathological feature of Alzheimer disease (AD). Its diagnostic utility is still unclear because amyloid plaques also occur in patients with non–AD dementia. OBJECTIVE To use individual participant data meta-analysis to estimate the prevalence of amyloid positivity on PET in a wide variety of dementia syndromes. DATA SOURCES The MEDLINE and Web of Science databases were searched from January 2004 to April 2015 for amyloid PET studies. STUDY SELECTION Case reports and studies on neurological or psychiatric diseases other than dementia were excluded. Corresponding authors of eligible cohorts were invited to provide individual participant data. DATA EXTRACTION AND SYNTHESIS Data were provided for 1359 participants with clinically diagnosed AD and 538 participants with non–AD dementia. The reference groups were 1849 healthy control participants (based on amyloid PET) and an independent sample of 1369 AD participants (based on autopsy). MAIN OUTCOMES AND MEASURES Estimated prevalence of positive amyloid PET scans according to diagnosis, age, and apolipoprotein E (APOE) ε4 status, using the generalized estimating equations method. RESULTS The likelihood of amyloid positivity was associated with age and APOE ε4 status. In AD dementia, the prevalence of amyloid positivity decreased from age 50 to 90 years in APOE ε4 noncarriers(86%[95%CI,73%–94%]at 50 years to 68% [95% CI,57%–77%] at 90 years; n = 377) and to a lesser degree in APOE ε4 carriers (97% [95% CI, 92%–99%] at 50 years to 90% [95% CI, 83%–94%] at 90 years; n = 593; P < .01). Similar associations of age and APOE ε4 with amyloid positivity were observed in participants with AD dementia at autopsy. In most non–AD dementias, amyloid positivity increased with both age (from 60 to 80 years) and APOE ε4 carriership. Total Participants Amyloid Positivity, % (95% CI) Age 60 y Age 80 y Dementia with Lewy bodies  emsp;APOE ε4 carrier 16 63 (48–80) 83 (67–92)  emsp;APOE ε4 noncarrier 18 29 (15–50) 54 (30–77) Frontotemporal dementia  emsp;APOE ε4 carrier 48 19 (12–28) 43 (35–50)  emsp;APOE ε4 noncarrier 160 5 (3–8) 14 (11–18) Vascular dementia  emsp;APOE ε4 carrier 30 25 (9–52) 64 (49–77)  emsp;APOE ε4 noncarrier 77 7 (3–18) 29 (17–43) CONCLUSIONS AND RELEVANCE Among participants with dementia, the prevalence of amyloid positivity was associated with clinical diagnosis, age, and APOE genotype. These findings indicate the potential clinical utility of amyloid imaging for differential diagnosis in early-onset dementia and to support the clinical diagnosis of participants with AD dementia and noncarrier APOE ε4 status who are older than 70 years.

Subfields: Neurology, Physiology, Psychiatry and Mental health

View Paper: https://www.semanticscholar.org/paper/2bf407b3169bffa2e40fb2d037fee56b93b01138

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  1. William J. Jagust

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  2. Suzanne L. Baker
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  5. Samuel N. Lockhart

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