Department of Nuclear Medicine, University of Leipzig Medical Center, Leipzig, Germany.
Department of Radiology, University of Leipzig Medical Center, Leipzig, Germany.
J Alzheimers Dis. 2022;88(3):1029-1035. doi: 10.3233/JAD-215619.
Alzheimer's disease and depression can start with combined cognitive and depressive symptoms [1, 2]. Accurate differential diagnosis is desired to initiate specific treatment.
We investigated whether amyloid-β PET imaging can discriminate both entities.
This retrospective observational study included 39 patients (20 female, age = 70±11years) with both cognitive and depressive symptoms who underwent amyloid-β PET imaging and in whom clinical follow-up data was available. Amyloid-β PET was carried out applying [18F]Florbetaben or [11C]PiB. The PET images were analyzed by standardized visual and relative-quantitative evaluation. Based on clinical follow-up (median of 2.4 years [range 0.3 to 7.0 years, IQR = 3.7 years] after amyloid PET imaging which was not considered in obtaining a definite diagnosis), discrimination ability between AD-related depression and pseudo-dementia in depression/depression with other comorbidities was determined.
Visually, all 10 patients with pseudo-dementia in depression and all 15 patients with other depression were rated as amyloid-β-negative; 2 of 14 patients with AD-related depression were rated amyloid-β-negative. ROC curve analysis of the unified composite standardized uptake value ratios (cSUVRs) was able to discriminate pseudo-dementia in depression from AD-related depression with high accuracy (AUC = 0.92). Optimal [18F]Florbetaben discrimination cSUVR threshold was 1.34. In congruence with the visual PET analysis, the resulting sensitivity of the relative-quantitative analysis was 86% with a specificity of 100%.
Amyloid-β PET can differentiate AD-related depression and pseudo-dementia in depression. Prospective clinical studies are warranted to confirm this result and to potentially broaden the spectrum of clinical applications for amyloid-β PET imaging.
阿尔茨海默病和抑郁症可表现为认知和抑郁症状同时存在[1,2]。准确的鉴别诊断有助于进行针对性治疗。
我们研究了淀粉样蛋白-β PET 成像是否可用于区分这两种疾病。
本回顾性观察性研究纳入了 39 名认知和抑郁症状均存在的患者（20 名女性，年龄 70±11 岁），并进行了淀粉样蛋白-β PET 成像，且这些患者的临床随访数据可查。应用[18F]Florbetaben 或[11C]PiB 进行淀粉样蛋白-β PET 成像。通过标准化的视觉和相对定量评估来分析 PET 图像。根据临床随访（进行淀粉样蛋白 PET 成像后中位时间为 2.4 年[范围 0.3 至 7.0 年，IQR=3.7 年]，未将其用于确定明确诊断），确定了在抑郁症/伴其他合并症的抑郁症中，AD 相关性抑郁与假性痴呆之间的鉴别能力。
视觉上，所有 10 例抑郁症伴假性痴呆患者和所有 15 例其他抑郁症患者均被评为淀粉样蛋白-β 阴性；14 例 AD 相关性抑郁患者中有 2 例被评为淀粉样蛋白-β 阴性。统一的综合标准化摄取值比（cSUVR）的 ROC 曲线分析能够准确地区分 AD 相关性抑郁与抑郁症伴假性痴呆（AUC=0.92）。最佳[18F]Florbetaben 鉴别 cSUVR 阈值为 1.34。与视觉 PET 分析一致，相对定量分析的灵敏度为 86%，特异性为 100%。
淀粉样蛋白-β PET 可区分 AD 相关性抑郁与抑郁症伴假性痴呆。需要开展前瞻性临床研究来证实这一结果，并可能拓宽淀粉样蛋白-β PET 成像的临床应用范围。
