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Relationship between comprehensive geriatric assessment and amyloid PET in older persons with MCI
Fulvio Lauretani1,2, Livia Ruffini3, Maura Scarlattei3
1Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43100, Parma, Italy. flauretani@ao.pr.it.
Background:
The association between amyloid deposition and cognitive, behavioral and physical performance in mild cognitive impairment (MCI) due to Alzheimer's disease (AD) has been poorly investigated, especially in older persons.
Methods:
We studied the in vivo correlation between the amyloid deposition at Positron Emission Tomography (amyloid-PET) and the presence of memory loss, reduced executive function, neuropsychiatric symptoms and physical performance in older persons with MCI. Amyloid-PET was performed with 18F-flutemetamol and quantitatively analyzed.
Results:
We evaluated 48 subjects, 21 men and 27 women. We performed in each patient a comprehensive geriatric assessment (CGA) including Mini Mental State Examination (MMSE), Clock Drawing Test (CDT), Activity Daily Living (ADL), Instrumental Activity of Daily Living (IADL), Neuropsychiatric inventory (NPI) questionnaire, 15 Geriatric Depression Scale (GDS), Short Physical Performance Battery (SPPB) and Hand Grip strength. Then, each patient underwent amyloid-PET. Mean age of the enrolled subjects was 74.6 ± 7.8 years. All of these subjects showed preserved cognitive function at MMSE > 24, while 29 of 48 subjects (61.0%) had altered CDT. Mean NPI score was 6.9 ± 5.9. The mean value of SPPB score was 9.0 ± 2.6, while the average muscle strength of the upper extremities measured by hand grip was 25.6 ± 7.7 Kg. CT/MRI images showed cortical atrophic changes in 26 of the 48 examined subjects (54.0%), while cerebrovascular modifications were present in 31 subjects (64.5%). Pathological burden of amyloid deposits was detected in 25 of 48 (52.0%) patients with a mean value of global z-score of 2.8 (subjects defined as MCI due to AD). After stratifying subjects in subclasses of clinical alterations, more probability of pathological amyloid deposition was found in subjects with impaired CDT and higher NPI score (O.R. = 3.45 [1.01-11.2], p = 0.04), with both impaired CDT and low physical performance (O.R. = 5.80 [1.04-32.2], p = 0.04), with altered CDT and high NPI score (O.R. = 7.98 [1.38-46.0], p = 0.02), and finally in those subjects with altered CDT, high NPI and low physical performance (O.R. = 5.80 [1.05-32.2], p = 0.04).
Conclusion:
Our findings support the recent hypothesis that amyloid deposition could be associated with multiple cerebral dysfunction, mainly affecting executive, behavioral and motor abilities.
Insights
Amyloid deposition in older adults with mild cognitive impairment is linked to executive, behavioral, and motor deficits. This study used amyloid-PET to correlate amyloid burden with cognitive and physical performance in MCI patients.
Area of Science:
- Neurology
- Geriatrics
- Radiology
Background:
- The relationship between amyloid plaque buildup and functional decline in mild cognitive impairment (MCI) due to Alzheimer's disease (AD) is not well understood, particularly in elderly populations.
- Investigating this association is crucial for understanding disease progression and developing targeted interventions.
Purpose of the Study:
- To examine the in vivo correlation between amyloid deposition, assessed via positron emission tomography (amyloid-PET), and cognitive, behavioral, and physical performance in older individuals with MCI.
- To identify specific clinical characteristics associated with higher amyloid burden in this population.
Main Methods:
- 48 participants (21 men, 27 women; mean age 74.6 years) with MCI underwent comprehensive geriatric assessments, including cognitive tests (MMSE, CDT), functional assessments (ADL, IADL), neuropsychiatric evaluation (NPI), and physical performance tests (SPPB, Hand Grip).
- Amyloid-PET imaging using 18F-flutemetamol was performed, and quantitative analysis of amyloid deposition was conducted.
- Statistical analysis, including odds ratios (O.R.), was used to determine the association between amyloid deposition and clinical variables.
Main Results:
- 52% of participants had detectable amyloid deposits.
- Amyloid deposition was significantly associated with impaired Clock Drawing Test (CDT) performance and higher scores on the Neuropsychiatric Inventory (NPI) (O.R. = 3.45, p=0.04).
- Increased amyloid burden was also linked to combinations of impaired CDT, low physical performance (O.R. = 5.80, p=0.04), and high NPI scores (O.R. = 7.98, p=0.02).
Conclusions:
- Amyloid deposition in MCI is associated with broader cerebral dysfunction beyond memory impairment.
- Findings support the hypothesis that amyloid buildup contributes to executive, behavioral, and motor deficits in older adults with MCI.
- Amyloid-PET imaging can help identify individuals with MCI at higher risk for multi-domain functional decline.
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