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Lack of Prognostic Significance of SPECT Abnormalities in Non-demented Elderly Subjects with Memory Loss

Published online by Cambridge University Press:  05 August 2019

R. McKelvey ,
H. Bergman ,
J. Stern ,
C. Rush ,
G. Zahirney  and
H. Chertkow
R. McKelvey
Affiliation:
Bloomfield Centre for Aging, Sir Mortimer B. Davis - Jewish General Hospital, McGill University, Montreal Division of Geriatric Medicine, Department of Medicine, Sir Mortimer B. Davis – Jewish General Hospital, McGill University Dalhousie University, Halifax, N.S., Dr. Everett Chalmers Hospital, Fredericton, N.B.
H. Bergman
Affiliation:
Division of Geriatric Medicine, Department of Medicine, Sir Mortimer B. Davis – Jewish General Hospital, McGill University
J. Stern
Affiliation:
Department of Nuclear Medicine, Sir Mortimer B. Davis - Jewish General Hospital, McGill University
C. Rush
Affiliation:
Department of Nuclear Medicine, Sir Mortimer B. Davis - Jewish General Hospital, McGill University
G. Zahirney
Affiliation:
Bloomfield Centre for Aging, Sir Mortimer B. Davis - Jewish General Hospital, McGill University, Montreal
H. Chertkow*
Affiliation:
Bloomfield Centre for Aging, Sir Mortimer B. Davis - Jewish General Hospital, McGill University, Montreal Division of Geriatric Medicine, Department of Medicine, Sir Mortimer B. Davis – Jewish General Hospital, McGill University Research Centre, Centre Hospitalier Côte-des-Neiges, Montreal
*
Lady Davis Institute and Sir Mortimer B. Davis - Jewish General Hospital, 3755 Chemin de la Cote Ste., Catherine, Montreal, Quebec, Canada H3T 1E2
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Abstract:

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Objective:

To determine if hypoperfusion abnormalities on single photon emission computed tomography (SPECT) are associated with poorer cognitive function at baseline or increased risk of decline in cognitive function and progression to dementia in memory-impaired but non-demented elderly subjects meeting the criteria for aging associated cognitive decline (AACD).

Design:

Cross sectional study of 36 AACD subjects comparing hexamethyl propylene-amine oxime (HMPAO) SPECT results rated by visual inspection with base line cognitive functioning. Prospective study of these AACD subjects with clinical and neuropsychological follow-up over 35 months.

Setting:

The memory clinic and nuclear medicine unit of a university teaching hospital.

Subjects:

Thirty-six subjects meeting the criteria for AACD recruited from patients seen on a physician referral basis.

Main outcome measures:

1) Baseline cognitive function as measured by the Mini Mental State Examination (MMSE), Boston naming, Logical Memory I subtest of the WAIS-R, and verbal fluency, correlated with SPECT status. 2) Decline in cognitive function as measured by clinical exam and the MMSE, with progression to dementia on follow-up being correlated with SPECT status at baseline.

Results:

18 of the 36 subjects progressed to dementia (probable Alzheimer's Disease) over follow-up. No correlation was found between the presence or absence of SPECT abnormality and MMSE or other cognitive measures. There was no correlation between the presence or absence of SPECT abnormality at initial examination, and cognitive decline according to the MMSE, or with the occurrence of clinical dementia on follow-up.

Conclusions:

We conclude that SPECT abnormalities assessed by visual inspection do not correlate with severity of impairment in AACD individuals, and are not useful in predicting progression to dementia in AACD subjects.

Résumé:

Résumé:<span class='italic'>But:</span>

Notre objectif était de déterminer si des anomalies d'hypoperfusion, à la tomographie à émetteur gamma (SPECT), sont associées à une fonction cognitive altérée à l'évaluation initiale ou à un risque accru de déclin des fonctions cognitives et à une progression vers la démence chez des sujets âgés non déments mais ayant des troubles de mémoire et qui satisfont aux critères de l'échelle du Déclin cognitif associé au vieillissement (DCAV).

<span class='italic'>Plan de l'étude:</span>

Il s'agit d'une étude transversale chez 36 sujets comparant les résultats de HMPAO SPECT, évalués par inspection, avec la fonction cognitive initiale. Nous avons étudié de façon prospective ces sujets avec DCAV au moyen d'un suivi clinique et neuropsychologique de plus de 35 mois.

<span class='italic'>Cadre de l'étude:</span>

Cette étude a été réalisée dans une clinique de la mémoire et une unité de médecine nucléaire d'un hôpital universitaire.

<span class='italic'>Sujets:</span>

Trente-six sujets qui rencontraient les critères de DCAV ont été recrutés parmi les patients référés à la clinique par un médecin.

<span class='italic'>Mesure principale des résultats:</span>

1. La fonction cognitive initiale, telle que mesurée par le “Mini Mental state examination” (MMSE), l'Épreuve de dénomination sous confrontation de Boston, le Sous-test de mémoire logique de l'Échelle clinique de mémoire du Weschler I, l'Épreuve de fluidité verbale, a été corrélée avec les résultats du SPECT. 2. Le déclin de la fonction cognitive mesuré par un examen clinique et le MMSE, avec progression vers la démence au cours du suivi, a été corrélé aux résultats du SPECT initial.

<span class='italic'>Résultats:</span>

18 des 36 sujets ont progressé vers la démence (maladie d'Alzheimer probable) au cours du suivi. Nous n'avons trouvé aucune corrélation entre la présence ou l'absence d'anomalies au SPECT et le MMSE ou les autres mesures cognitives. Il n'y avait pas de corrélation entre la présence ou l'absence d'anomalies au SPECT à l'examen initial et le déclin cognitif selon le MMSE ou le développement d'une démence au cours du suivi clinique.

<span class='italic'>Conclusions:</span>

Nous concluons qu'il n'y a pas de corrélation entre les anomalies au SPECT, qui sont notées par inspection visuelle, et la sévérité de l'atteinte chez les sujets avec DCAV et que ces anomalies ne sont pas utiles pour prédire la progression de la démence chez ces sujets.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 26 , Issue 1 , February 1999 , pp. 23 - 28
Copyright
Copyright © The Canadian Journal of Neurological 1999

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