Diverging patterns of amyloid deposition and hypometabolism in clinical variants of probable Alzheimer's disease
Open accessAbstract
The factors driving clinical heterogeneity in Alzheimer's disease are not well understood. This study assessed the relationship between amyloid deposition, glucose metabolism and clinical phenotype in Alzheimer's disease, and investigated how these relate to the involvement of functional networks. The study included 17 patients with early-onset Alzheimer's disease (age at onset <65 years), 12 patients with logopenic variant primary progressive aphasia and 13 patients with posterior cortical atrophy [whole Alzheimer's disease group: age = 61.5 years (standard deviation 6.5 years), 55% male]. Thirty healthy control subjects [age = 70.8 (3.3) years, 47% male] were also included. Subjects underwent positron emission tomography with (11)C-labelled Pittsburgh compound B and (18)F-labelled fluorodeoxyglucose. All patients met National Institute on Ageing-Alzheimer's Association criteria for probable Alzheimer's disease and showed evidence of amyloid deposition on (11)C-labelled Pittsburgh compound B positron emission tomography. We hypothesized that hypometabolism patterns would differ across variants, reflecting involvement of specific functional networks, whereas amyloid patterns would be diffuse and similar across variants. We tested these hypotheses using three complimentary approaches: (i) mass-univariate voxel-wise group comparison of (18)F-labelled fluorodeoxyglucose and (11)C-labelled Pittsburgh compound B; (ii) generation of covariance maps across all subjects with Alzheimer's disease from seed regions of interest specifically atrophied in each variant, and comparison of these maps to functional network templates; and (iii) extraction of (11)C-labelled Pittsburgh compound B and (18)F-labelled fluorodeoxyglucose values from functional network templates. Alzheimer's disease clinical groups showed syndrome-specific (18)F-labelled fluorodeoxyglucose patterns, with greater parieto-occipital involvement in posterior cortical atrophy, and asymmetric involvement of left temporoparietal regions in logopenic variant primary progressive aphasia. In contrast, all Alzheimer's disease variants showed diffuse patterns of (11)C-labelled Pittsburgh compound B binding, with posterior cortical atrophy additionally showing elevated uptake in occipital cortex compared with early-onset Alzheimer's disease. The seed region of interest covariance analysis revealed distinct (18)F-labelled fluorodeoxyglucose correlation patterns that greatly overlapped with the right executive-control network for the early-onset Alzheimer's disease region of interest, the left language network for the logopenic variant primary progressive aphasia region of interest, and the higher visual network for the posterior cortical atrophy region of interest. In contrast, (11)C-labelled Pittsburgh compound B covariance maps for each region of interest were diffuse. Finally, (18)F-labelled fluorodeoxyglucose was similarly reduced in all Alzheimer's disease variants in the dorsal and left ventral default mode network, whereas significant differences were found in the right ventral default mode, right executive-control (both lower in early-onset Alzheimer's disease and posterior cortical atrophy than logopenic variant primary progressive aphasia) and higher-order visual network (lower in posterior cortical atrophy than in early-onset Alzheimer's disease and logopenic variant primary progressive aphasia), with a trend towards lower (18)F-labelled fluorodeoxyglucose also found in the left language network in logopenic variant primary progressive aphasia. There were no differences in (11)C-labelled Pittsburgh compound B binding between syndromes in any of the networks. Our data suggest that Alzheimer's disease syndromes are associated with degeneration of specific functional networks, and that fibrillar amyloid-β deposition explains at most a small amount of the clinico-anatomic heterogeneity in Alzheimer's disease.
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Discordance between imaging biomarkers has been noted in sporadic AD.
“Discordance between imaging biomarkers has been noted in sporadic AD 37–44.”
From Spatial patterns of neuroimaging biomarker change in individuals from families with autosomal dominant Alzheimer's disease: a longitudinal study (2018) · cites this paper as [41]
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Self-citationTemporoparietal atrophy: a marker of AD pathology independent of clinical diagnosis
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Similar amyloid-β burden in posterior cortical atrophy and Alzheimer's disease
de Souza, L. C., Corlier, F. W., Habert, M., Uspenskaya, O., Maroy, R., Lamari, F., Marie Chupin, A., Lehéricy, S., Olivier Colliot, A., Hahn‐Barma, V., et al. (2011) · Brain · doi:10.1093/brain/awr130 · Cited by 127 · see citing works
Distinct clinical and metabolic deficits in PCA and AD are not related to amyloid distribution
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Self-citationPreclinical Evidence of Alzheimer Changes
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“…in mouse models correlate with neural activity (Cirrito et al., 2005; Bero et al., 2011), and that amyloid-b accumulation in humans occurs in highly interconnected cortical hubs (Buckner et al., 2009), even in preclinical stages (Mintun et al., 2006; Fripp et al., 2008; Mormino et al., 2011).”
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Global gray matter changes in posterior cortical atrophy: A serial imaging study
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Self-citationPosterior Cortical Atrophy: A Rare Form of Dementia with in vivo Evidence of Amyloid-β Accumulation
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Self-citationBlood–Brain Barrier Dysfunction as a Cause and Consequence of Alzheimer's Disease
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Self-citationAmyloid biomarkers in Alzheimer's disease
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Brain fluorodeoxyglucose (FDG) PET in dementia
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18F-flortaucipir (AV-1451) tau PET in frontotemporal dementia syndromes
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Within-patient correspondence of amyloid-β and intrinsic network connectivity in Alzheimer’s disease
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ApoE influences regional white-matter axonal density loss in Alzheimer's disease
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Diagnosis and Management of Posterior Cortical Atrophy
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Self-citation
- Authors
- Lehmann, M., Ghosh, P. M., Madison, C., Laforce, R., Corbetta-Rastelli, C., Weiner, M. W., Greicius, M. D., Seeley, W. W., Gorno-Tempini, M. L., Rosen, H. J., Miller, B. L., Jagust, W. J., & Rabinovici, G. D.
- Affiliations
- University of California, San Francisco (US)
- University of California, Berkeley (US)
- San Francisco VA Medical Center (US)
- Stanford Medicine (US)
- Lawrence Berkeley National Laboratory (US)
- Corresponding author
- Lehmann, Manja
- ORCID
- Venue
- Brain
- Publisher
- Oxford University Press (OUP)
- Published
- 2013-01-28
- Volume
- 136
- Issue
- 3
- Pages
- 844-858
- ISSN
- 0006-8950 (ISSN-L)
- 1460-2156
- PMC
- PMC3580269
- OpenAlex
- W2131864441
- Cited by
- 325
- References
- 93
- Citations by year
- 2026: 5 · 2025: 17 · 2024: 9 · 2023: 15 · 2022: 19 · 2021: 32 · 2020: 35 · 2019: 36 · 2018: 22 · 2017: 26 · 2016: 29 · 2015: 39 · 2014: 24 · 2013: 17
- FWCI
- 25.72
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Brain (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Institutional Research Information System (Università degli Studi di Trento) (submittedVersion)
- Funders
- Alzheimer's Association (K23-AG031861, P50 AG023501, AG027859, NIRG-07-59422, P01-AG1972403, ZEN-08-87090)
- Hellman Family Foundation
- National Institute on Aging (P01 AG1972403, R01AG027859, K23AG031861, P01AG019724, P50AG023501)
- National Institute of Neurological Disorders and Stroke (R01NS073498, R01NS050915)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
- Life Sciences › Neuroscience › Cognitive Neuroscience › Functional Brain Connectivity Studies
- Keywords
- Alzheimer's disease, amyloid deposition, glucose hypometabolism, clinical heterogeneity, posterior cortical atrophy, logopenic variant primary progressive aphasia, early-onset Alzheimer's disease, functional networks, frontoparietal network, language network, Pittsburgh compound B, FDG-PET, brain atrophy, temporal lobe, occipital cortex
- MeSH terms
- Aged, Alzheimer Disease, Amyloid, Female, Glucose, Humans, Image Interpretation, Computer-Assisted, Male, Middle Aged, Neuropsychological Tests, Phenotype, Radiopharmaceuticals, Fluorodeoxyglucose F18, Positron-Emission Tomography, Plaque, Amyloid
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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