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Impact of the New Conceptual Framework of Alzheimer’s Disease in Imaging Studies

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PET and SPECT in Neurology

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Abstract

For both research and clinical settings, the importance of an accurate diagnosis of AD is imperative given its much-feared consequences, which cannot be understated. The diagnosis of AD should be restricted to the presence of both: (1) a clinical phenotype, either typical (characterized by an amnestic syndrome of the hippocampal type) or atypical (including the posterior variant, the logopenic variant and the frontal variant, to which it may be possible to add the cortico-basal syndrome), and (2) in vivo evidence of positive pathophysiological markers, acquired with molecular neuroimaging or with cerebrospinal fluid investigation. In the preclinical state of the disease, evidence reported in the last few years suggests that the presence of tau and amyloid positivity is not sufficient to definitively predict the invariable occurrence of symptoms. Therefore, measures of pathophysiological markers are not recommended in cognitively unimpaired individuals, in the absence of therapies or prevention programs showing efficacy on delaying onset of disease (although this may happen outside the clinical setting for specific reasons, for clinical trials, research projects or cohort studies).

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Authors and Affiliations

  1. GRC no 21, Alzheimer Precision Medicine, Sorbonne Université, Paris, France

    Bruno Dubois & Nicolas Villain

  2. Alzheimer Research Centre (IM2A), Hôpital Pitié-Salpêtrière, AP-HP Sorbonne Université, Paris, France

    Bruno Dubois & Nicolas Villain

  3. Institut du Cerveau et de la Moelle Epinière – ICM, INSERM U1127, CNRS 7225, Sorbonne Université, Paris, France

    Bruno Dubois & Nicolas Villain

  4. Pacific University School of Graduate Psychology, Forest Grove, OR, USA

    Claudia Jacova

  5. Prevail Therapeutics, New York, NY, USA

    Olga Uspenskaya

Authors
  1. Bruno Dubois
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  2. Nicolas Villain
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  3. Claudia Jacova
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  4. Olga Uspenskaya
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Corresponding author

Correspondence to Bruno Dubois .

Editor information

Editors and Affiliations

  1. Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands

    Rudi A. J. O. Dierckx

  2. Faculty of Electrical Engineering, Medical Engineering and Computer Science, Offenburg University, Offenburg, Germany

    Andreas Otte

  3. Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands

    Erik F. J. de Vries

  4. Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands

    Aren van Waarde

  5. Neurology, University Medical Center Groningen, Groningen, The Netherlands

    Klaus L. Leenders

Glossary

AD dementia

When cognitive symptoms interfere with activity of daily living.

Alzheimer’s disease (AD)

The whole clinical phase, no longer restricted to the dementia syndrome.

Alzheimer’s pathology

Underlying neurobiological changes responsible for AD

Asymptomatic at risk

Cognitively normal individuals with positive pathophysiological biomarkers.

Atypical AD

Less common but well-characterized clinical phenotypes that occur with Alzheimer’s pathology. The diagnosis of AD needs in vivo evidence of pathophysiological markers.

Mild cognitive impairment (MCI)

Patients for whom there is no disease clearly identified.

Mixed AD

Patients who fulfill the criteria for AD and additionally present with clinical and biomarkers evidence of other comorbid disorders.

Pathophysiological markers

Biological changes that reflect the underlying AD pathology (CSF changes; PET-amyloid). They are markers of diagnosis.

Prodromal AD

The early symptomatic, predementia phase of AD.

Topographical biomarkers

Downstream markers of neurodegeneration that can be structural (MRI) or metabolic (FDG-PET). They are markers of progression.

Typical AD

The most common clinical phenotype of AD, characterized by an amnestic syndrome of the hippocampal type.

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Dubois, B., Villain, N., Jacova, C., Uspenskaya, O. (2021). Impact of the New Conceptual Framework of Alzheimer’s Disease in Imaging Studies. In: Dierckx, R.A.J.O., Otte, A., de Vries, E.F.J., van Waarde, A., Leenders, K.L. (eds) PET and SPECT in Neurology. Springer, Cham. https://doi.org/10.1007/978-3-030-53168-3_13

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