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Positive rate and quantification of amyloid pathology with [18F]florbetapir in the urban Chinese population

  • Nuclear Medicine
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Abstract

Objectives

Amyloid deposition is considered the initial pathology in Alzheimer’s disease (AD). Personalized management requires investigation of amyloid pathology and the risk factors for both amyloid pathology and cognitive decline in the Chinese population. We aimed to investigate amyloid positivity and deposition in AD patients, as well as factors related to amyloid pathology in Chinese cities.

Methods

This cross-sectional multicenter study was conducted in Shanghai and Zhengzhou, China. All participants were recruited from urban communities and memory clinics. Amyloid positivity and deposition were analyzed based on amyloid positron emission tomography (PET). We used partial least squares (PLS) models to investigate how related factors contributed to amyloid deposition and cognitive decline.

Results

In total, 1026 participants were included: 768 participants from the community-based cohort (COMC) and 258 participants from the clinic-based cohort (CLIC). The overall amyloid-positive rates in individuals with clinically diagnosed AD, mild cognitive impairment (MCI), and normal cognition (NC) were 85.8%, 44.5%, and 26.9%, respectively. The global amyloid deposition standardized uptake value ratios (SUVr) (reference: cerebellar crus) were 1.44 ± 0.24, 1.30 ± 0.22, and 1.24 ± 0.14, respectively. CLIC status, apolipoprotein E (ApoE) ε4, and older age were strongly associated with amyloid pathology by PLS modeling.

Conclusion

The overall amyloid-positive rates accompanying AD, MCI, and NC in the Chinese population were similar to those in published cohorts of other populations. ApoE ε4 and CLIC status were risk factors for amyloid pathology across the AD continuum. Education was a risk factor for amyloid pathology in MCI. Female sex and age were risk factors for amyloid pathology in NC.

Clinical relevance statement

This study provides new details about amyloid pathology in the Chinese population. Factors related to amyloid deposition and cognitive decline can help to assess patients’ AD risk.

Key Points

• We studied amyloid pathology and related risk factors in the Chinese population.

•·The overall amyloid-positive rates in individuals with clinically diagnosed AD, MCI, and NC were 85.8%, 44.5%, and 26.9%, respectively.

• These overall amyloid-positive rates were in close agreement with the corresponding prevalence for other populations.

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Abbreviations

AD:

Alzheimer’s disease

AFT:

Animal fluency test

ANCOVA:

Analysis of covariance

ApoE :

Apolipoprotein E

AVLT-LDR:

Long-delayed recall of the Auditory Verbal Learning Test

Aβ:

β-Amyloid

BH:

Benjamini and Hochberg

BNT:

Boston Naming Test

CLIC:

Clinic-based cohort

COMC:

Community-based cohort

CT:

Computed tomography

FBP:

Filtered back-projection

FDR:

False discovery rate

FWHM:

Full width at half maximum

MCI:

Mild cognitive impairment

MMSE:

Mini-Mental State Examination

MNI:

Montreal Neurological Institute

MoCA-B:

Montreal Cognitive Assessment-Basic

MP-RAGE:

Magnetization-prepared rapid gradient echo

MRI:

Magnetic resonance imaging

NC:

Normal cognition

NIA-AA:

National Institute on Aging and Alzheimer’s Association

PET:

Positron emission tomography

PLS:

Partial least squares

PVC:

Partial volume error correction

ROI:

Region of interest

SD:

Standard deviation

STT:

Shape Trail Test

SUVr:

Standardized uptake value ratio

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Acknowledgements

The authors thank Jianfei Xiao, Xiangqing Xie, Yue Qian, and Zhiwei Pan for their generous assistance with this study.

Funding

This study has received funding by the National Key R&D Program of China (2016YFC1306305, 2018YFE0203600); STI2030-Major Projects (2022ZD0213800); the National Science Foundation of China (81801752, 81571345); the Shanghai Sailing Program (18YF1403200, 19YF1405300); the startup fund of Huashan Hospital, Fudan University (2017QD081); Shanghai Municipal Key Clinical Specialty (shslczdzk03402); Shanghai Municipal Science and Technology Major Project (No. 2018SHZDZX01); and Shanghai Rising-Star Program (21QA1405800) and ZJLab.

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Author notes

  1. Kun He, Binyin Li, and Lin Huang contributed equally to this work.

Authors and Affiliations

  1. Department of Nuclear Medicine & PET Center, Huashan Hospital, Fudan University, Shanghai, 200040, China

    Kun He, Junpeng Li, Jie Wang, Qi Huang, Shuhua Ren, Donglang Jiang, Yihui Guan & Fang Xie

  2. Department of Neurology and Institute of Neurology, School of Medicine Affiliated Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, 200020, China

    Binyin Li

  3. Department of Gerontology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, 200233, China

    Lin Huang, Jingchao Hu & Qihao Guo

  4. Department of Nuclear Medicine, Shanghai East Hospital, Tongji University, Shanghai, 200120, China

    Jun Zhao

  5. Department of Nuclear Medicine, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China

    Fengchun Hua

  6. Department of Geriatric Psychiatry, Shanghai Mental Health Centre, Shanghai Jiaotong University School of Medicine, Shanghai, 200122, China

    Tao Wang

  7. Department of Neurology, Huashan Hospital, Fudan University, Shanghai, 200040, China

    Keliang Chen

  8. Department of Nuclear Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China

    Shasha Xu & Xingmin Han

  9. Laboratory of Clinical Nuclear Medicine, Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China

    Huawei Cai

  10. School of Nursing, Shanghai Jiaotong University, Shanghai, 200025, China

    Jingchao Hu

  11. Banner Alzheimer Institute, Arizona State University, University of Arizona and Arizona Alzheimer’s Consortium, Phoenix, AZ, USA

    Kewei Chen

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  1. Kun He
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  2. Binyin Li
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  3. Lin Huang
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  4. Jun Zhao
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Corresponding authors

Correspondence to Qihao Guo or Fang Xie.

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The scientific guarantor of this publication is Fang Xie.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

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Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained. This study has been approved by the Institutional Review Board of Huashan Hospital, Fudan University.

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• retrospective

• cross sectional study

• multicenter study

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He, K., Li, B., Huang, L. et al. Positive rate and quantification of amyloid pathology with [18F]florbetapir in the urban Chinese population. Eur Radiol (2023). https://doi.org/10.1007/s00330-023-10366-z

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