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[IC‐P‐074]: LONGITUDINAL DIFFUSION TENSOR IMAGING AS A PREDICTOR OF COGNITIVE DOMAINS DECLINE IN EARLY STAGE PARKINSON's DISEASE: ICICLE‐PD STUDY
Author(s) -
Minett Thais,
Su Li,
Mak Elijah,
Williams Guy B.,
Firbank Michael J.,
Lawson Rachael A.,
Yarnall Alison J.,
Duncan Gordon W.,
Owen Adrian M.,
Khoo Tien K.,
Brooks David J.,
Rowe James B.,
Barker Roger A.,
Burn David,
O'Brien John T.
Publication year - 2017
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2017.06.2347
Subject(s) - fractional anisotropy , diffusion mri , parkinson's disease , white matter , cognition , cognitive decline , dementia , medicine , population , psychology , disease , cardiology , magnetic resonance imaging , psychiatry , radiology , environmental health
Background: Delirium, an acute neuropsychiatric disorder frequently seen in hospitalized elderly patients, is associated with increased risk of cognitive decline. It remains unclear if that risk is linked to acceleration by delirium of pre-existing disease, possibly increasing in itself the risk of delirium under physiological stress, and if so whether certain specific conditions are more likely to be involved. To begin clarifying this, we analyzed the cerebral FDG PET (CPET) patterns reported in patients with prolonged delirium. Methods: We retrospectively reviewed cerebral CPET studies in hospitalized patients who presented prolonged (>7 days) delirium according to the Confusion Assessment Method criteria between 01/2012 and 12/2015 at CHUM. Subjects had to be> 65 years old and without a history of dementia, idiopathic Parkinson’s disease, or significant psychiatric disorder. They were age and sex matched with randomly selected outpatient controls imaged with CPET for evaluation of cognitive impairment. Imaging studies were re-interpreted by 2 Nuclear Medicine physicians trained in neuroimaging, blinded to clinical diagnosis. Results:We reviewed 1604 files, with 28 meeting inclusion criteria (mean age: 81 6 8, 64% male). Although not statistically significant, patients with delirium were more likely to show a scintigraphic pattern of neurodegenerative disease than controls (89 % vs. 68%, p 1⁄4 0.101). Alzheimer’s was the most frequent diagnosis for both groups (17 in the delirium group, 10 controls; p 1⁄4 0,108). The scintigraphic pattern was compatible with Lewy body pathology in 9 patients with prolonged delirium compared to only 1 in controls (32% vs. 4%, p 1⁄4 0.012). Moreover, the scintigraphic pattern was suggestive of co-occurring neural pathologies in 18 cases of patients with prolonged delirium while only 8 controls were so classified (64% vs. 29%, p 1⁄4 0.015). Conclusions: The frequency of a PET-defined neurodegenerative condition in patients with an episode of prolonged delirium is high but similar to that of outpatients with cognitive deterioration. However, the repartition across neurodegenerative processes encountered in the prolonged delirium group differs from that of controls, with Lewy body disease and mixed pathologies being over-represented in the delirium group; AD remains the most frequent diagnosis in both groups.