Raita Fukasawa1, Haruo Hanyu2, Soichiro Shimizu1, Hidekazu Kanetaka1, Hirofumi Sakurai1, Kenji Ishii3. 1. Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan. 2. Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan. Electronic address: h-hanyu@tokyo-med.ac.jp. 3. Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan; Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.
Abstract
AIMS: We attempted to identify a dementia subgroup with characteristics associated with diabetes mellitus (DM)-related metabolic abnormalities, referred to as diabetes-related dementia, using longitudinal single photon emission computed tomography (SPECT) and Pittsburgh compound-B (PiB) positron emission tomography (PET). METHODS: We classified 175 patients with clinically diagnosed Alzheimer disease (AD) and DM into 4 subgroups based on brain imaging in a 2013 study. Among them, we investigated follow-up SPECT studies in 29 patients of an AD group showing decreased regional cerebral blood flow (rCBF) of the parietotemporal lobe on initial SPECT and 18 patients of a diabetes-related dementia group showing neither decreased rCBF of the parietotemporal lobe nor cerebrovascular disease, which is strongly associated with DM-related factors. Eleven of them underwent PiB PET. RESULTS: Follow-up SPECT showed more profound rCBF reduction in the parietotemporal lobe and other areas of the AD group, whereas follow-up SPECT showed an rCBF reduction in small areas of the frontotemporal and limbic lobes of the diabetes-related dementia group. Six of 9 patients with diabetes-related dementia were negative or equivocal for PiB binding. CONCLUSION: A subset of a dementia subgroup with characteristics predominantly associated with DM-related factors may underlie a pathophysiology different from AD, although these patients were clinically diagnosed as having AD. The identification of diabetes-related dementia may be necessary for considering an appropriate therapy and prevention in clinical practice.
AIMS: We attempted to identify a dementia subgroup with characteristics associated with diabetes mellitus (DM)-related metabolic abnormalities, referred to as diabetes-related dementia, using longitudinal single photon emission computed tomography (SPECT) and Pittsburgh compound-B (PiB) positron emission tomography (PET). METHODS: We classified 175 patients with clinically diagnosed Alzheimer disease (AD) and DM into 4 subgroups based on brain imaging in a 2013 study. Among them, we investigated follow-up SPECT studies in 29 patients of an AD group showing decreased regional cerebral blood flow (rCBF) of the parietotemporal lobe on initial SPECT and 18 patients of a diabetes-related dementia group showing neither decreased rCBF of the parietotemporal lobe nor cerebrovascular disease, which is strongly associated with DM-related factors. Eleven of them underwent PiB PET. RESULTS: Follow-up SPECT showed more profound rCBF reduction in the parietotemporal lobe and other areas of the AD group, whereas follow-up SPECT showed an rCBF reduction in small areas of the frontotemporal and limbic lobes of the diabetes-related dementia group. Six of 9 patients with diabetes-related dementia were negative or equivocal for PiB binding. CONCLUSION: A subset of a dementia subgroup with characteristics predominantly associated with DM-related factors may underlie a pathophysiology different from AD, although these patients were clinically diagnosed as having AD. The identification of diabetes-related dementia may be necessary for considering an appropriate therapy and prevention in clinical practice.
Authors: Steven E Arnold; Zoe Arvanitakis; Shannon L Macauley-Rambach; Aaron M Koenig; Hoau-Yan Wang; Rexford S Ahima; Suzanne Craft; Sam Gandy; Christoph Buettner; Luke E Stoeckel; David M Holtzman; David M Nathan Journal: Nat Rev Neurol Date: 2018-01-29 Impact factor: 42.937