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J Alzheimers Dis. 2016 Oct 18;54(4):1319-1331.

Combination of Structural MRI and FDG-PET of the Brain Improves Diagnostic Accuracy in Newly Manifested Cognitive Impairment in Geriatric Inpatients.

Author information

1
Berlin Center for Advanced Neuroimaging, Bernstein Center for Computational Neuroscience, Charité - Universitätsmedizin Berlin, Berlin, Germany.
2
Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.
3
Evangelisches Geriatriezentrum Berlin, Berlin, Germany.
4
Geriatric Research Group, Department of Geriatric Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.
5
Jung Diagnostics GmbH, Hamburg, Germany.
6
Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany.
7
Department of Neurology, University Hospital Magdeburg, Magdeburg, Germany.
8
Vivantes Ida Wolff Krankenhaus, Berlin, Germany.
9
Department of Psychiatry and Psychotherapy Charité Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany.
10
Department of Internal Medicine/Infectious Diseases and Pulmonary Medicine, Charité - Universitätsmedizin Berlin, Germany.
11
Center for Stroke Research Berlin, Charité, Berlin, Germany.
12
Lipid Clinic at the Interdisciplinary Metabolism Center, Charité - Universitätsmedizin, Berlin, Germany.
13
AXA Research Fund & UPMC Chair, Sorbonne Universités, Université Pierre et Marie Curie, Paris 06, Institut de la Mémoire et de la Maladied' Alzheimer (IM2A) & Institut du Cerveau et de la Moelleépinière (ICM), Département de Neurologie, Hôpital de la Pitié-Salpêtrière, Paris, France.

Abstract

BACKGROUND:

The cause of cognitive impairment in acutely hospitalized geriatric patients is often unclear. The diagnostic process is challenging but important in order to treat potentially life-threatening etiologies or identify underlying neurodegenerative disease.

OBJECTIVE:

To evaluate the add-on diagnostic value of structural and metabolic neuroimaging in newly manifested cognitive impairment in elderly geriatric inpatients.

METHODS:

Eighty-one inpatients (55 females, 81.6±5.5 y) without history of cognitive complaints prior to hospitalization were recruited in 10 acute geriatrics clinics. Primary inclusion criterion was a clinical hypothesis of Alzheimer's disease (AD), cerebrovascular disease (CVD), or mixed AD+CVD etiology (MD), which remained uncertain after standard diagnostic workup. Additional procedures performed after enrollment included detailed neuropsychological testing and structural MRI and FDG-PET of the brain. An interdisciplinary expert team established the most probable etiologic diagnosis (non-neurodegenerative, AD, CVD, or MD) integrating all available data. Automatic multimodal classification based on Random Undersampling Boosting was used for rater-independent assessment of the complementary contribution of the additional diagnostic procedures to the etiologic diagnosis.

RESULTS:

Automatic 4-class classification based on all diagnostic routine standard procedures combined reproduced the etiologic expert diagnosis in 31% of the patients (p = 0.100, chance level 25%). Highest accuracy by a single modality was achieved by MRI or FDG-PET (both 45%, p≤0.001). Integration of all modalities resulted in 76% accuracy (p≤0.001).

CONCLUSION:

These results indicate substantial improvement of diagnostic accuracy in uncertain de novo cognitive impairment in acutely hospitalized geriatric patients with the integration of structural MRI and brain FDG-PET into the diagnostic process.

KEYWORDS:

Cognitive impairment; geriatric inpatients; magnetic resonance imaging; multimodal classification; positron emission tomography

PMID:
27567842
DOI:
10.3233/JAD-160380
[Indexed for MEDLINE]

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