Department of Neurology, Harvard Medical School, 1861Brigham and Women's Hospital, Boston, MA, USA.
Department of Neurology, Harvard Medical School, 168383Massachusetts General Hospital, Boston, MA, USA.
Am J Alzheimers Dis Other Demen. 2023 Jan-Dec;38:15333175231160005. doi: 10.1177/15333175231160005.
In older adults with cognitive decline and epilepsy, diagnosing the etiology of cognitive decline is challenging. We identified 6 subjects enrolled in the Imaging Dementia-Evidence of Amyloid Imaging Scanning (IDEAS) study and nonlesional epilepsy. Three cognitive neurologists reviewed each case to determine the likelihood of underlying Alzheimer's disease (AD) pathology. Their impressions were compared to amyloid PET findings. In 3 cases the impression was concordant with PET findings. In 2 cases "possibly suggestive," the PET reduced diagnostic uncertainty, with 1 having a PET without elevated amyloid and the other PET with intermediate amyloid. In the remaining case with lack of reviewer concordance, the significance of PET with elevated amyloid remains uncertain. This case series highlights that in individuals with a history of epilepsy and cognitive decline, amyloid PET can be a useful tool in evaluating the etiology of cognitive decline when used in an appropriate context.
在认知能力下降和癫痫的老年患者中,诊断认知能力下降的病因具有挑战性。我们确定了 6 名参加成像痴呆-淀粉样蛋白成像扫描(IDEAS)研究和非病变性癫痫的受试者。三位认知神经科医生对每个病例进行了审查,以确定是否存在潜在的阿尔茨海默病(AD)病理。他们的印象与淀粉样 PET 结果进行了比较。在 3 例中,印象与 PET 结果一致。在 2 例“可能提示”的情况下,PET 降低了诊断的不确定性,其中 1 例 PET 显示淀粉样蛋白不升高,另 1 例 PET 显示淀粉样蛋白中间升高。在其余的病例中,由于缺乏审阅者的一致性,PET 显示淀粉样蛋白升高的意义仍不确定。本病例系列强调,在有癫痫和认知能力下降病史的个体中,当在适当的背景下使用时,淀粉样 PET 可以成为评估认知能力下降病因的有用工具。