Does a positive Pittsburgh Compound B scan in a patient with dementia equal Alzheimer disease?

Abstract:

IMPORTANCE:The clinical role of amyloid brain positron emission tomographic imaging in the diagnosis of Alzheimer disease is currently being formulated. The specificity of a positive amyloid scan is a matter of contention. OBSERVATIONS:An 83-year-old Canadian man presented with a 5-year history of predominantly short-term memory loss and functional impairment. Clinical evaluation revealed significant, gradually progressive short-term memory loss in the absence of any history of strokes or other neuropsychiatric symptoms. The patient met clinical criteria for probable Alzheimer disease but had a higher than expected burden of white matter disease on magnetic resonance imaging. A positron emission tomographic Pittsburgh Compound B scan was highly positive in typical Alzheimer disease distribution. The patient died of an intracerebral hemorrhage 6 months after the assessment. Autopsy revealed cerebral amyloid angiopathy in the complete absence of amyloid plaques or neurofibrillary tangles. CONCLUSIONS AND RELEVANCE:This patient demonstrates that a positive Pittsburgh Compound B scan in a patient with clinical dementia meeting criteria for probable Alzheimer disease is not proof of an Alzheimer disease pathophysiological process. A positive Pittsburgh Compound B scan in typical Alzheimer disease distribution in a patient with dementia can be secondary to cerebral amyloid angiopathy alone.

journal_name

JAMA Neurol

journal_title

JAMA neurology

authors

Ducharme S,Guiot MC,Nikelski J,Chertkow H

doi

10.1001/jamaneurol.2013.420

subject

Has Abstract

pub_date

2013-07-01 00:00:00

pages

912-4

issue

7

eissn

2168-6149

issn

2168-6157

pii

1688416

journal_volume

70

pub_type

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