Cited by 677Dementia and Cognitive Impairment ResearchAlzheimer's disease research and treatmentsMedical Imaging Techniques and Applications

Prevalence of Amyloid PET Positivity in Dementia Syndromes: A Meta-analysis

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Ossenkoppele, Rik, Jansen, Willemijn J., Rabinovici, Gil D., Knol, Dirk L., van der Flier, Wiesje M., van Berckel, Bart N. M., Scheltens, Philip, Visser, Pieter Jelle +48 more·2015·JAMA

Abstract

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 (dementia with Lewy bodies: carriers [n = 16], 63% [95% CI, 48%-80%] at 60 years to 83% [95% CI, 67%-92%] at 80 years; noncarriers [n = 18], 29% [95% CI, 15%-50%] at 60 years to 54% [95% CI, 30%-77%] at 80 years; frontotemporal dementia: carriers [n = 48], 19% [95% CI, 12%-28%] at 60 years to 43% [95% CI, 35%-50%] at 80 years; noncarriers [n = 160], 5% [95% CI, 3%-8%] at 60 years to 14% [95% CI, 11%-18%] at 80 years; vascular dementia: carriers [n = 30], 25% [95% CI, 9%-52%] at 60 years to 64% [95% CI, 49%-77%] at 80 years; noncarriers [n = 77], 7% [95% CI, 3%-18%] at 60 years to 29% [95% CI, 17%-43%] at 80 years. 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.

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Crossref · 10.1001/jama.2015.4669

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  • Prevalence-adjusted PPVs and NPVs were calculated using the Bayesian formula provided by Altman and Bland using age-associated prevalence of Aβ+ from published meta-analyses.

    “Prevalence-adjusted (that is, pretest probability-adjusted) PPVs and NPVs were calculated using the Bayesian formula provided by Altman and Bland15,64,65 using age-associated prevalence of Aβ+ in MCI, probable AD dementia and non-AD dementia syndromes (frontotemporal dementia, vascular dementia and corticobasal syndrome) from published meta-analyses18,19 using the following formulas:”

    From Diagnosis of Alzheimer's disease using plasma biomarkers adjusted to clinical probability (2024) · cites this paper as [18]

    The Results section, “Prevalence of Amyloid Positivity According to Diagnosis, Age, and APOE” (page unavailable), reports age-associated amyloid-positivity estimates for AD dementia and the named non-AD dementia syndromes. The paper’s Results describes a dementia cohort, not an MCI cohort, so it does not support the MCI prevalence part. The Bayesian formula is attributed to other citations in the citing sentence, not to this paper. (LLM, conf=0.88)

    Experimental — accuracy not yet measured
  • Nonamnestic clinical presentations-language, visuospatial, and executive disorders-may also be due to AD.

    “Nonamnestic clinical presentations, that is, language, visuospatial, and executive disorders, may also be due to AD [63–66].”

    From NIA‐AA Research Framework: Toward a biological definition of Alzheimer's disease (2018) · cites this paper as [66]

    The Methods (page unavailable) include posterior cortical atrophy and logopenic-variant primary progressive aphasia as atypical AD presentations, supporting the visuospatial and language examples. The Discussion (page unavailable) says AD may underlie some clinically non-AD syndromes, but it does not specifically identify executive disorders as an AD presentation. (LLM, conf=0.82)

    Experimental — accuracy not yet measured
  • Prevalence of amyloid-β pathology is closely linked to age and clinical syndrome.

    “As the prevalence of amyloid-β pathology is closely linked to age and clinical syndrome18–20, clinical and demographic information can be used to infer the clinical pretest probability of amyloid-β positivity (Aβ+) based on standard clinical assessments17,21,22.”
  • Amyloid PET positivity prevalence estimates employed in the study are derived from meta-analyses of predominantly memory clinic and research settings.

    “Sixth, the amyloid PET positivity prevalence estimates employed in our study are derived from meta-analyses of predominantly memory clinic and research settings18,19.”
  • Prevalence of Aβ+ is substantially higher in APOE ε4 carriers.

    “Owing to the substantially higher prevalence of Aβ+ in APOE ε4 carriers18,19,28, plasma biomarkers had higher PPVs for brain amyloid-β, particularly in individuals with MCI.”

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Authors
Ossenkoppele, R., Jansen, W. J., Rabinovici, G. D., Knol, D. L., van der Flier, W. M., van Berckel, B. N. M., Scheltens, P., Visser, P. J., Verfaillie, S. C. J., Zwan, M. D., Adriaanse, S. M., Lammertsma, A. A., Barkhof, F., Jagust, W. J., Miller, B. L., Rosen, H. J., Landau, S. M., Villemagne, V. L., Rowe, C. C., Lee, D. Y., Na, D. L., Seo, S. W., Sarazin, M., Roe, C. M., Sabri, O., Barthel, H., Koglin, N., Hodges, J., Leyton, C. E., Vandenberghe, R., van Laere, K., Drzezga, A., Forster, S., Grimmer, T., Sánchez-Juan, P., Carril, J. M., Mok, V., Camus, V., Klunk, W. E., Cohen, A. D., Meyer, P. T., Hellwig, S., Newberg, A., Frederiksen, K. S., Fleisher, A. S., Mintun, M. A., Wolk, D. A., Nordberg, A., Rinne, J. O., Chételat, G., Lleo, A., Blesa, R., Fortea, J., Madsen, K., Rodrigue, K. M., & Brooks, D. J.
Affiliations
  • University of California, San Francisco (US)
  • Maastricht University (NL)
  • Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
  • Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, the Netherlands 6Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
  • Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
  • Lawrence Berkeley National Laboratory (US)
  • Austin Hospital (AU)
  • Seoul National University (KR)
  • Sungkyunkwan University (KR)
  • Inserm (FR)
  • Washington University in St. Louis (US)
  • Leipzig University (DE)
  • Piramal (Germany) (DE)
  • Neuroscience Research Australia (AU)
  • KU Leuven (BE)
  • Laboratory for Cognitive Neurology and Alzheimer Research Center, Katholieke Universiteit Leuven, Catholic University Leuven, Belgium
  • University of Cologne (DE)
  • Department of Nuclear Medicine, Technische Universitaet Muenchen, Munich, Germany
  • TUM Klinikum (DE)
  • IFIMAV and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Marqués de Valdecilla University Hospital, Cantabria, Spain
  • Universidad de Cantabria (ES)
  • Chinese University of Hong Kong (HK)
  • Université de Tours (FR)
  • University of Pittsburgh (US)
  • University Medical Center Freiburg (DE)
  • Thomas Jefferson University (US)
  • University of Copenhagen (DK)
  • Banner Alzheimer’s Institute (US)
  • Avid Radiopharmaceuticals (United States) (US)
  • University of Pennsylvania (US)
  • Karolinska Institutet (SE)
  • University of Turku (FI)
  • Department of Neurology, Universitat Autònoma de Barcelona, Spain
  • Universitat Autònoma de Barcelona (ES)
  • Copenhagen University Hospital (DK)
  • The University of Texas at Dallas (US)
  • Imperial College London (GB)
Corresponding author
Ossenkoppele, Rik
Venue
JAMA
Published
2015-05-19
Volume
313
Issue
19
Pages
1939
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
OpenAlex
W1747781838
Cited by
677
References
55
Citations by year
2026: 47 · 2025: 57 · 2024: 53 · 2023: 64 · 2022: 57 · 2021: 70 · 2020: 70 · 2019: 66 · 2018: 70 · 2017: 53 · 2016: 53 · 2015: 16 · 2012: 1
FWCI
8.60
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
  • LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (publishedVersion, other-oa)
  • Pure Amsterdam UMC (publishedVersion, other-oa)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
  • VU Research Portal (publishedVersion, other-oa)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
  • Research Publications (Maastricht University) (submittedVersion, other-oa)
  • UCL Discovery (University College London) (submittedVersion)
  • Lirias (submittedVersion)
  • mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
  • UCrea (University of Cantabria) (submittedVersion, cc-by)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Funders
  • Alzheimer's Association (U01 AG016976, P50 AG005681, U01 AG024904)
  • Bristol-Myers Squibb (U01 AG024904, AG024904)
  • Eli Lilly and Company (U01 AG024904, AG024904)
  • Pfizer (AG024904, 115372, U01 AG024904)
  • AstraZeneca
  • Biogen (U01 AG024904, AG024904)
  • American Parkinson Disease Association
  • University of Pennsylvania
  • F. Hoffmann-La Roche (AG024904, U01 AG024904)
  • Medpace (U01 AG024904)
  • Meso Scale Diagnostics (U01 AG024904, AG024904)
  • Synarc (U01 AG024904)
  • Washington University in St. Louis
  • Alzheimer's Disease Neuroimaging Initiative (U01AG024904, AG024904)
  • Dagmar Marshalls Fond
  • Amorfix Life Sciences
  • BioClinica (U01 AG024904, AG024904)
  • University of Pittsburgh
  • Thomas Jefferson University
  • Science and Industry Endowment Fund
  • Northern California Institute for Research and Education (U01 AG024904)
  • European Federation of Pharmaceutical Industries and Associations (FP7/20072013, 115372)
  • Lui Che Woo Institute of Innovative Medicine
  • Imperial College London
  • European Commission (U01 AG024904, 2007–2013, FP7 2007-2013, LSHB-CT-2005-512146, FP7/2007, 115372)
  • Bayer HealthCare
  • Commonwealth Scientific and Industrial Research Organisation
  • Deutsche Forschungsgemeinschaft (HE 4560/1-2, DR 445/3-1, 115372, FP7/2007–2013, DR 445/4-1)
  • Institut National de la Santé et de la Recherche Médicale (INSERM U930)
  • Edith Cowan University
  • Gentofte Hospital
  • Dementia Collaborative Research Centres, Australia
  • Lundbeckfonden
  • Eisai (U01 AG024904, AG024904)
  • Karolinska Institutet
  • Turun Yliopisto
  • Technische Universität München
  • Center for Translational Molecular Medicine (02N-101)
  • Universidad de Cantabria
  • Universitat Autònoma de Barcelona
  • Servier (AG024904, U01 AG024904)
  • Turun Yliopistollinen Keskussairaala
  • University of Texas at Dallas
  • Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas
  • IXICO (AG024904, U01 AG024904)
  • Grifols
  • Région Normandie
  • National Institutes of Health (3u01ag024904-10s2, FP7/2007-2013, UL1TR000448, AG016976, U01-AG024904, AG024904, AG005681, NS075321)
  • Genentech (AG024904, U01 AG024904)
  • University of California, Los Angeles
  • University of California, San Diego
  • Avid Radiopharmaceuticals
  • Canadian Institutes of Health Research (U01 AG024904)
  • Charles F. and Joanne Knight Alzheimer Disease Research Center, Washington University in St. Louis
  • Medical Research Council (FP7/20072013, U01 AG024904)
  • National Health and Medical Research Council
  • Instituto de Salud Carlos III
  • Health and Health Services Research Fund (06070231)
  • National Institute on Aging (U01-AG-024904, R01AG045611, U01AG016976, P30AG010124, R01AG032306, P50AG005681, P01AG003991, P01AG019724, P01AG026276, P50AG023501)
  • National Institute of Neurological Disorders and Stroke (RF1NS075321, NS075321, R01NS075321, FP7/2007-2013)
  • National Center for Research Resources (U01 AG024904, UL1RR024992)
  • National Center for Advancing Translational Sciences
  • Janssen Alzheimer Immunotherapy Research And Development (AG024904, U01 AG024904)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Medical Imaging Techniques and Applications
Keywords
amyloid PET, amyloid-beta, Alzheimer's disease, non-AD dementia, dementia with Lewy bodies, multiple system atrophy, APOE ε4, age, amyloid plaques, individual patient data meta-analysis, autopsy comparison, cognitive impairment without dementia, neurodegeneration
MeSH terms
Adult, Age Factors, Aged, Aged, 80 and over, Brain, Dementia, Female, Genotype, Humans, Male, Middle Aged, Risk Factors, Prevalence, Amyloid beta-Peptides, Positron-Emission Tomography, Apolipoprotein E4

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