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Seoul criteria for PiB(-) subcortical vascular dementia based on clinical and MRI variables
Geon Ha Kim1, Jae Hong Lee, Sang Won Seo
1From the Department of Neurology (G.H.K., J.H.J.), Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul; Departments of Neurology (J.H.L.) and Nuclear Medicine (S.J.O., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul; Departments of Neurology (S.W.S., B.S.Y., H.C., H.J.K., J.H.C., D.L.N.), Nuclear Medicine (Y.S.C., K.H.L.), and Radiology (S.T.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; Department of Neurology (Y.N.), Gachon University Gil Medical Center, Incheon; and Department of Neurology (C.W.Y.), Inha University Hospital, Inha University School of Medicine, Incheon, Korea.
Objective:
The purpose of this study was to propose new criteria for differentiating Pittsburgh compound B (PiB)-negative from PiB-positive subcortical vascular dementia (SVaD) using clinical and MRI variables.
Methods:
We measured brain amyloid deposition using PiB-PET in 77 patients with SVaD. All patients met DSM-IV criteria for vascular dementia and had severe white matter hyperintensities on MRI, defined as a cap or band ≥ 10 mm as well as a deep white matter lesion ≥ 25 mm. Eleven models were considered to differentiate PiB(-) from PiB(+) SVaD using 4 variables, including age, number of lacunes, medial temporal atrophy (MTA), and APOE ε4. The ideal cutoff values in each of the 11 models were selected using the highest Youden index.
Results:
A total of 49 of 77 patients (63.6%) tested negative for PiB retention, while 28 (36.4%) tested positive for PiB retention. The ideal model for differentiating PiB(-) from PiB(+) SVaD was as follows: age ≤ 75 years, ≥ 5 lacunes, and MTA ≤ 3, which together yielded an accuracy of 67.5%.
Conclusion:
When patients meet the DSM-IV criteria for vascular dementia and also have severe white matter hyperintensities, younger age, greater number of lacunes, and lesser MTA, these are predictive of a PiB(-) scan in patients with SVaD.
Classification Of Evidence:
This study provides Class II evidence that the combination of younger age, greater number of lacunes, and lesser MTA identifies patients with SVaD at lower risk of Alzheimer disease pathology.
Insights
New criteria using age, lacunes, and medial temporal atrophy (MTA) can differentiate Pittsburgh compound B (PiB)-negative from PiB-positive subcortical vascular dementia (SVaD). This helps identify SVaD patients with lower risk of Alzheimer disease pathology.
Area of Science:
- Neurology
- Neuroimaging
- Dementia Research
Background:
- Subcortical vascular dementia (SVaD) diagnosis can be challenging.
- Differentiating amyloid-positive (PiB-positive) from amyloid-negative (PiB-negative) SVaD is crucial for understanding underlying pathology.
- Amyloid deposition, detected by Pittsburgh compound B (PiB) Positron Emission Tomography (PET), is a key biomarker.
Purpose of the Study:
- To develop and validate new criteria for distinguishing PiB-negative from PiB-positive SVaD.
- To utilize clinical and magnetic resonance imaging (MRI) variables for this differentiation.
- To improve diagnostic accuracy in SVaD patients.
Main Methods:
- 77 SVaD patients underwent PiB-PET to measure brain amyloid deposition.
- Patients met DSM-IV criteria for vascular dementia and had severe white matter hyperintensities on MRI.
- Eleven models were tested using age, number of lacunes, medial temporal atrophy (MTA), and APOE ε4 to differentiate PiB-negative from PiB-positive SVaD.
Main Results:
- 63.6% of patients were PiB-negative, and 36.4% were PiB-positive.
- The optimal model for differentiation included age ≤ 75 years, ≥ 5 lacunes, and MTA ≤ 3.
- This model achieved an accuracy of 67.5% in differentiating PiB-negative from PiB-positive SVaD.
Conclusions:
- In SVaD patients with severe white matter hyperintensities, younger age, more lacunes, and less MTA predict a PiB-negative scan.
- These findings suggest a lower likelihood of Alzheimer disease pathology in these patients.
- The proposed criteria offer a valuable tool for clinical differentiation within SVaD.
