- Email: [email protected]
CLINICAL UTILITY OF AMYLOID PET IN AMNESTIC MILD COGNITIVE IMPAIRMENT
P616
Poster Presentations: Monday, July 17, 2017
Table 1 Individual Outcome Cognition ACE-r MMSE MoCA TICS Trail making B: time Trail making B: correct answers IQ code Animal naming Stroop interference: accuracy Stroop interference: time Global Wei-Lachin Other outcomes mRS BI EQ-5D HUS Zung Depression scale Telephone MMSE Global Wei-Lachin
Mean difference (95% CI)
P-value
4.4 (-2.1,10.9) 1.9 (-0.3, 4.1) 1.2 (-0.9, 3.2) 1.3 (-0.9, 3.5) -25.8 (-61.2, 9.6) 2.7 (0.3, 5.0) -0.1 (-0.3, 0.1) 3.0 (0.8, 5.3) 2.7 (0.2, 5.1) -14.0 (-29.8, 1.8) 4.30
0.18 0.085 0.26 0.25 0.15 0.025 0.43 0.008 0.033 0.082 0.023
-0.5 (-1.0, 0.0) 7.5 (-0.5, 15.4) 0.1 (0.0, 0.2) -3.0 (-8.2, 2.1) 1.7 (-0.4, 3.9) 2.14
0.036 0.067 0.084 0.25 0.12 0.023
number of secondary outcomes, a statistically significant difference was found between treatment groups in favour of intensive lipid lowering. Results from analyses of individual outcomes are given in Table 1. The Wei-Lachin test showed a statistically significant difference in favour of intensive lipid lowering for a global cognition outcome (Mann-Whitney statistic¼4.3, p¼0.023) and for a global outcome consisting of measures of dependency, disability, quality of life, mood and cognition (Mann-Whitney statistic¼2.14, p¼0.023). Conclusions: Intensive lipid lowering improves cognition and overall recovery on global aggregate outcomes. Global outcomes are more statistically efficient than individual tests and provide an overall estimate of treatment effect encompassing a range of outcomes of relevance after stroke. Global outcomes could be of interest to patients involved in clinical trials as it gives an estimate of overall recovery as opposed to recovery in one specific domain.
P2-030
WITHDRAWN
P2-031
CLINICAL UTILITY OF AMYLOID PET IN AMNESTIC MILD COGNITIVE IMPAIRMENT
Ko Woon Kim1 and Sang Won Seo1,2, 1Samsung Medical Center, Seoul, Republic of South Korea; 2Neuroscience Center, Samsung Medical Center, Seoul, Republic of South Korea. Contact e-mail: [email protected] Background: Mild cognitive impairment (MCI) refers to a transi-
tional zone between normal ageing and dementia. Despite clinical trials, a standard treatment strategy for MCI patients has not been established. Previous amyloid PET studies also showed that just 50-60% MCI patients had amyloid positivity, which predicted their worse clinical outcomes. The purpose of this study is to examine how an amyloid PET scan helps guide doctors in treating mild cognitive impairment (MCI) patients. Methods: 202 data on all am-
yloid PET scan from May 2009 through May 2016 were retrieved from Samsung medical center. We compared pre-PET intended management to post-PET actual management recorded 90 days after the scan. Examples of changes in management include: use of Alzheimer’s drug therapy, other drug therapy such as ginkgo biloba. Results: Among 168 MCI patients, the overall treatment change rate was 61%. In contrast, treatment non-change rate was 43%. Of the 43% patients with treatment non-change, amyloid positive group occupied as high as 39% compared amyloid negative group occupied 61%. Of the 57% patients with treatment change, amyloid positive group was 52% and amyloid negative group was only 30%. 18% patients showed irrelevant treatment change. Conclusions: The results of this study showed amyloid PET data could influence physicians’ decision for MCI. Especially, physicians confidently started choline esterase inhibitors when amyloid PET result was positive. However, when amyloid PET showed a negative result, physicians hesitated stop choline esterase inhibitors. Future multi-center studies will be required to ascertain the clinical roll of brain amyloid PET that is an important factor to change treatment plan for MCI patients.
P2-032
PREVENTIVE EFFECT OF RIFAMPICIN ON ALZHEIMER’S DISEASE NEEDS AT LEAST 450 MG DAILY FOR ONE YEAR: AN FDGPET FOLLOW-UP STUDY
Tomomichi Iizuka1 and Masashi Kameyama2,3, 1Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan; 2Keio University, Tokyo, Japan; 3Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan. Contact e-mail: [email protected] Background: Rifampicin, a well-known antibiotic, was reported to inhibit amyloid-b oligomerization and tau hyperphosphorylation in mouse models and the findings indicated that rifampicin could serve as a promising available medicine for the prevention of Alzheimer’s disease (AD). To examine whether rifampicin has such preventive effects in human, we retrospectively reviewed 18FFDG-PET findings of elderly patients with mycobacterium infection treated with rifampicin. Methods: Forty non-demented elderly patients treated with rifampicin for mycobacterium infections who showed AD-type hypometabolism on FDG-PET were enrolled. The hypometabolic patterns were evaluated with stereotaxic statistical analysis and region of interest analysis. Results: Decrease of FDG uptake in posterior cingulate cortex (PCC) and parietal association cortex was considered as a typical hypometabolic pattern of AD. Before treatment, AD-type hypometabolism was observed in twelve patients. After 12 months of rifampicin therapy (450mg/day), FDG-uptake in PCC was not significantly changed in six patients. Another six patients who received six months of rifampicin showed decrease of FDG-uptake in PCC. In patients who underwent FDG-PET only after treatment, metabolic decline in PCC was significantly milder in patients with 12 months of rifampicin treatment than those with six months. Multiple regression analysis revealed that dose of rifampicin, treatment duration and interval between twice of FDG-PET acquisitions significantly influenced FDG uptake in PCC. Conclusions: Our results suggested that the preventive effect of rifampicin depended on the dose and the treatment duration and that the effect needs at least 450mg daily for one year.
Poster Presentations: Monday, July 17, 2017
Table 1 Individual Outcome Cognition ACE-r MMSE MoCA TICS Trail making B: time Trail making B: correct answers IQ code Animal naming Stroop interference: accuracy Stroop interference: time Global Wei-Lachin Other outcomes mRS BI EQ-5D HUS Zung Depression scale Telephone MMSE Global Wei-Lachin
Mean difference (95% CI)
P-value
4.4 (-2.1,10.9) 1.9 (-0.3, 4.1) 1.2 (-0.9, 3.2) 1.3 (-0.9, 3.5) -25.8 (-61.2, 9.6) 2.7 (0.3, 5.0) -0.1 (-0.3, 0.1) 3.0 (0.8, 5.3) 2.7 (0.2, 5.1) -14.0 (-29.8, 1.8) 4.30
0.18 0.085 0.26 0.25 0.15 0.025 0.43 0.008 0.033 0.082 0.023
-0.5 (-1.0, 0.0) 7.5 (-0.5, 15.4) 0.1 (0.0, 0.2) -3.0 (-8.2, 2.1) 1.7 (-0.4, 3.9) 2.14
0.036 0.067 0.084 0.25 0.12 0.023
number of secondary outcomes, a statistically significant difference was found between treatment groups in favour of intensive lipid lowering. Results from analyses of individual outcomes are given in Table 1. The Wei-Lachin test showed a statistically significant difference in favour of intensive lipid lowering for a global cognition outcome (Mann-Whitney statistic¼4.3, p¼0.023) and for a global outcome consisting of measures of dependency, disability, quality of life, mood and cognition (Mann-Whitney statistic¼2.14, p¼0.023). Conclusions: Intensive lipid lowering improves cognition and overall recovery on global aggregate outcomes. Global outcomes are more statistically efficient than individual tests and provide an overall estimate of treatment effect encompassing a range of outcomes of relevance after stroke. Global outcomes could be of interest to patients involved in clinical trials as it gives an estimate of overall recovery as opposed to recovery in one specific domain.
P2-030
WITHDRAWN
P2-031
CLINICAL UTILITY OF AMYLOID PET IN AMNESTIC MILD COGNITIVE IMPAIRMENT
Ko Woon Kim1 and Sang Won Seo1,2, 1Samsung Medical Center, Seoul, Republic of South Korea; 2Neuroscience Center, Samsung Medical Center, Seoul, Republic of South Korea. Contact e-mail: [email protected] Background: Mild cognitive impairment (MCI) refers to a transi-
tional zone between normal ageing and dementia. Despite clinical trials, a standard treatment strategy for MCI patients has not been established. Previous amyloid PET studies also showed that just 50-60% MCI patients had amyloid positivity, which predicted their worse clinical outcomes. The purpose of this study is to examine how an amyloid PET scan helps guide doctors in treating mild cognitive impairment (MCI) patients. Methods: 202 data on all am-
yloid PET scan from May 2009 through May 2016 were retrieved from Samsung medical center. We compared pre-PET intended management to post-PET actual management recorded 90 days after the scan. Examples of changes in management include: use of Alzheimer’s drug therapy, other drug therapy such as ginkgo biloba. Results: Among 168 MCI patients, the overall treatment change rate was 61%. In contrast, treatment non-change rate was 43%. Of the 43% patients with treatment non-change, amyloid positive group occupied as high as 39% compared amyloid negative group occupied 61%. Of the 57% patients with treatment change, amyloid positive group was 52% and amyloid negative group was only 30%. 18% patients showed irrelevant treatment change. Conclusions: The results of this study showed amyloid PET data could influence physicians’ decision for MCI. Especially, physicians confidently started choline esterase inhibitors when amyloid PET result was positive. However, when amyloid PET showed a negative result, physicians hesitated stop choline esterase inhibitors. Future multi-center studies will be required to ascertain the clinical roll of brain amyloid PET that is an important factor to change treatment plan for MCI patients.
P2-032
PREVENTIVE EFFECT OF RIFAMPICIN ON ALZHEIMER’S DISEASE NEEDS AT LEAST 450 MG DAILY FOR ONE YEAR: AN FDGPET FOLLOW-UP STUDY
Tomomichi Iizuka1 and Masashi Kameyama2,3, 1Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan; 2Keio University, Tokyo, Japan; 3Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan. Contact e-mail: [email protected] Background: Rifampicin, a well-known antibiotic, was reported to inhibit amyloid-b oligomerization and tau hyperphosphorylation in mouse models and the findings indicated that rifampicin could serve as a promising available medicine for the prevention of Alzheimer’s disease (AD). To examine whether rifampicin has such preventive effects in human, we retrospectively reviewed 18FFDG-PET findings of elderly patients with mycobacterium infection treated with rifampicin. Methods: Forty non-demented elderly patients treated with rifampicin for mycobacterium infections who showed AD-type hypometabolism on FDG-PET were enrolled. The hypometabolic patterns were evaluated with stereotaxic statistical analysis and region of interest analysis. Results: Decrease of FDG uptake in posterior cingulate cortex (PCC) and parietal association cortex was considered as a typical hypometabolic pattern of AD. Before treatment, AD-type hypometabolism was observed in twelve patients. After 12 months of rifampicin therapy (450mg/day), FDG-uptake in PCC was not significantly changed in six patients. Another six patients who received six months of rifampicin showed decrease of FDG-uptake in PCC. In patients who underwent FDG-PET only after treatment, metabolic decline in PCC was significantly milder in patients with 12 months of rifampicin treatment than those with six months. Multiple regression analysis revealed that dose of rifampicin, treatment duration and interval between twice of FDG-PET acquisitions significantly influenced FDG uptake in PCC. Conclusions: Our results suggested that the preventive effect of rifampicin depended on the dose and the treatment duration and that the effect needs at least 450mg daily for one year.