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Amyloid Positivity in the Alzheimer/Subcortical-Vascular Spectrum.

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  • 1From the Department of Neurology, Sungkyunkwan University School of Medicine (S.H.K., H.J., H.L., H.J.K., S.W.S., D.L.N.), Neuroscience Center (S.H.K., H.J., H.L., H.J.K., S.W.S., D.L.N.), and Stem Cell & Regenerative Medicine Institute (D.L.N.), Samsung Medical Center; Department of Neurology (S.H.K.), Korea University Guro Hospital, Korea University College of Medicine, Seoul; Chicago College of Osteopathic Medicine (M.E.K.), Midwestern University, IL; New York University (H.K.), NY; and Department of Health Sciences and Technology, SAIHST (D.L.N.), Sungkyunkwan University, Seoul, Korea.

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Summary

β-amyloid (Aβ) positivity increases with cognitive decline but decreases with white matter hyperintensities (WMH). Higher education, no diabetes, and APOE ε4 presence are linked to Aβ positivity.

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Area of Science:

  • Neurology
  • Neuroimaging
  • Geriatrics

Background:

  • Alzheimer's disease and cerebral small vessel diseases are leading causes of cognitive impairment.
  • Understanding the interplay between β-amyloid (Aβ) deposition and white matter hyperintensities (WMH) is crucial for diagnosing and managing cognitive decline.

Purpose of the Study:

  • To investigate the frequency of Aβ positivity across different cognitive states (subjective cognitive decline, mild cognitive impairment, dementia) and WMH severity levels.
  • To determine factors associated with Aβ positivity, controlling for WMH, and vice versa.

Main Methods:

  • Analyzed data from 1,047 individuals undergoing Aβ PET scans.
  • Classified participants into 9 groups based on cognition and WMH severity.
  • Assessed clinical and genetic factors, including APOE ε4 genotype, diabetes, and education level.

Main Results:

  • Aβ positivity significantly increased with cognitive impairment severity (15.7% in SCD to 76.2% in dementia).
  • Aβ positivity decreased with increasing WMH severity and number of lacunes.
  • Higher education, absence of diabetes, and APOE ε4 presence were independently associated with Aβ positivity.

Conclusions:

  • Alzheimer's disease and cerebral small vessel diseases may represent a continuum.
  • Findings provide valuable insights for clinicians regarding the associations between Aβ, WMH, and cognitive status.