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[18F]Fluorodeoxyglucose position emission tomography for differential diagnosis of depressive cognitive impairment: incremental value compared with clinical diagnosis

Published online by Cambridge University Press:  08 May 2025

Sabine Hellwig Open the ORCID record for Sabine Hellwig [Opens in a new window] ,
Lars Frings ,
Meret Heibel ,
Nils Schroeter ,
Ganna Blazhenets ,
Katharina Domschke Open the ORCID record for Katharina Domschke [Opens in a new window] ,
Joachim Brumberg  and
Philipp T. Meyer
Sabine Hellwig*
Affiliation:
Department of Psychiatry and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
Lars Frings
Affiliation:
Department of Nuclear Medicine, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
Meret Heibel
Affiliation:
Department of Psychiatry and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
Nils Schroeter
Affiliation:
Department of Neurology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
Ganna Blazhenets
Affiliation:
Department of Nuclear Medicine, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
Katharina Domschke
Affiliation:
Department of Psychiatry and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany German Center for Mental Health (DZPG), Partner Site Berlin, Berlin, Germany
Joachim Brumberg
Affiliation:
Department of Nuclear Medicine, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
Philipp T. Meyer
Affiliation:
Department of Nuclear Medicine, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
*
Correspondence: Sabine Hellwig. Email: [email protected]
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Abstract

Background

Assessment of regional glucose metabolism by [18F]fluorodeoxyglucose position emission tomography ([18F]FDG PET) serves as a biomarker for differential diagnosis of dementia. Conversely, depressive cognitive impairment shows no abnormalities on cerebral [18F]FDG PET.

Aims

This study validates the diagnostic value of [18F]FDG PET in addition to clinical diagnosis in a real-life gerontopsychiatric clinical population.

Method

Ninety-eight consecutive patients with depression and cognitive impairment were included. Baseline clinical diagnoses were independently established before and after disclosure of [18F]FDG PET, and dichotomised into neurodegenerative or non-neurodegenerative diseases (level 1). Subsequently, neurodegenerative cases were allocated to diagnostic subgroups (Alzheimer’s disease, Lewy body diseases, frontotemporal lobar degeneration, neurodegenerative other; level 2). An interdisciplinary, biomarker-supported consensus diagnosis after a median follow-up of 6.6 month after [18F]FDG PET served as reference. Changes of clinical diagnoses and diagnostic accuracy were assessed.

Results

After disclosure of [18F]FDG PET, level-1 clinical diagnoses changed in 23% (95% CI 16–33%) of cases, improving the diagnostic accuracy from 72% (95% CI 62–81%) to 92% (95% CI 84–96%) (P < 0.001). [18F]FDG PET was of particular value for exclusion of neurodegenerative disease. Concerning level-2 decisions, the clinical diagnoses changed in 30% (95% CI 21–40%) of cases, increasing its accuracy from 64% (95% CI 54–74%) to 85% (95% CI 76–91%) (P < 0.001). A major fraction of incorrect level-2 diagnoses comprised Alzheimer’s disease misdiagnosed as Lewy body diseases.

Conclusions

[18F]FDG PET provides a significant incremental diagnostic value beyond the clinical diagnosis in depressive cognitive impairment. Thus, [18F]FDG PET should be considered in the diagnostic work-up of patients with mental disorders and cognitive impairment.

Keywords

Positron emission tomography[18F]FDGlate-life depressioncognitive impairmentdementia
Type
Original Article
Information
The British Journal of Psychiatry , First View , pp. 1 - 8
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Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of Royal College of Psychiatrists

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