Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA.
Northern California Institute of Research and Education, San Francisco, California, USA.
Alzheimers Dement. 2023 Dec;19(12):5605-5619. doi: 10.1002/alz.13164. Epub 2023 Jun 8.
How to detect patterns of greater tau burden and accumulation is still an open question.
An unsupervised data-driven whole-brain pattern analysis of longitudinal tau positron emission tomography (PET) was used first to identify distinct tau accumulation profiles and then to build baseline models predictive of tau-accumulation type.
The data-driven analysis of longitudinal flortaucipir PET from studies done by the Alzheimer's Disease Neuroimaging Initiative, Avid Pharmaceuticals, and Harvard Aging Brain Study (N = 348 cognitively unimpaired, N = 188 mild cognitive impairment, N = 77 dementia), yielded three distinct flortaucipir-progression profiles: stable, moderate accumulator, and fast accumulator. Baseline flortaucipir levels, amyloid beta (Aβ) positivity, and clinical variables, identified moderate and fast accumulators with 81% and 95% positive predictive values, respectively. Screening for fast tau accumulation and Aβ positivity in early Alzheimer's disease, compared to Aβ positivity with variable tau progression profiles, required 46% to 77% lower sample size to achieve 80% power for 30% slowing of clinical decline.
Predicting tau progression with baseline imaging and clinical markers could allow screening of high-risk individuals most likely to benefit from a specific treatment regimen.
如何检测到更大的 tau 负担和积累模式仍然是一个悬而未决的问题。
首先使用无监督的数据驱动的全脑纵向 tau 正电子发射断层扫描（PET）模式分析来识别不同的 tau 积累特征，然后构建预测 tau 积累类型的基线模型。
对来自阿尔茨海默病神经影像学倡议、Avid 制药公司和哈佛衰老大脑研究（N=348 名认知正常、N=188 名轻度认知障碍、N=77 名痴呆）的纵向氟脱氧酪氨酸 PET 数据进行的数据分析，得出了三种不同的氟脱氧酪氨酸进展特征：稳定型、中度积累型和快速积累型。基线氟脱氧酪氨酸水平、淀粉样蛋白β（Aβ）阳性和临床变量可分别识别中度和快速积累者，阳性预测值分别为 81%和 95%。与 Aβ 阳性且 tau 进展特征不同相比，在早期阿尔茨海默病中筛查快速 tau 积累和 Aβ 阳性，需要 46%至 77%的样本量减少，才能实现 80%的功效，即临床下降减缓 30%。
用基线成像和临床标志物预测 tau 进展可以筛选出最有可能从特定治疗方案中受益的高危个体。
