ABSTRACT
BACKGROUND: It remains unknown whether the noninvasive evaluation of the degree of amyloid deposition in the myocardium can predict the prognosis of patients with light chain (AL) cardiac amyloidosis. OBJECTIVES: The purpose of this study was to demonstrate that 11C-Pittsburgh B compound positron emission tomography (11C-PiB PET) is useful for prognostication of AL cardiac amyloidosis by noninvasively imaging the myocardial AL amyloid deposition. METHODS: This study consecutively enrolled 41 chemotherapy-naïve AL cardiac amyloidosis patients. The amyloid deposit was quantitatively assessed with amyloid P immunohistochemistry in endomyocardial biopsy specimens and was compared with the degree of myocardial 11C-PiB uptake on PET. The primary endpoint was a composite of all-cause death, heart transplantation, and acute decompensated heart failure. RESULTS: The degree of myocardial 11C-PiB PET uptake was significantly higher in the cardiac amyloidosis patients compared with normal subjects and correlated well with the degree of amyloid deposit on histology (R2 = 0.343, p < 0.001). During follow-up (median: 423 days, interquartile range: 93 to 1,222 days), 24 patients experienced the primary endpoint. When the cardiac amyloidosis patients were divided into tertiles by the degree of myocardial 11C-PiB PET uptake, patients with the highest PiB uptake experienced the worst clinical event-free survival (log-rank p = 0.014). The degree of myocardial PiB PET uptake was a significant predictor of clinical outcome on multivariate Cox regression analysis (adjusted hazard ratio: 1.185; 95% confidence interval: 1.054 to 1.332; p = 0.005). CONCLUSIONS: These proof-of-concept results show that noninvasive evaluation of myocardial amyloid load by 11C-PiB PET reflects the degree of amyloid deposit and is an independent predictor of clinical outcome in AL cardiac amyloidosis patients.
Subject(s)
Amyloidosis/diagnostic imaging , Heart/diagnostic imaging , Positron-Emission Tomography , Aged , Aniline Compounds , Biopsy , Female , Heart Failure/diagnostic imaging , Humans , Immunohistochemistry , Male , Middle Aged , Myocardium/pathology , Prognosis , Proportional Hazards Models , Prospective Studies , ThiazolesABSTRACT
AIM: Although delusions are one of the most prominent psychiatric symptoms in Alzheimer's disease (AD), research on the subtypes, prevalence and associated factors of delusions, especially in drug (psychotropic)-naïve patients, has been limited. METHODS: Patients (n = 230) with psychotropic-naïve (drug-naïve) probable AD were assessed with the Korean Neuropsychiatric Inventory (K-NPI) delusion subscale at the time of initial presentation. After determining the four delusion subtypes (paranoid, misidentification, mixed and expansive delusion), clinical characteristics and prevalence of each type were compared. RESULTS: Delusions were present in 63 patients (27.4%). Among those patients, paranoid delusions were the most common type of delusion (38, 60.3%), followed by misidentification delusions (12, 19.0%), then mixed delusions (11, 17.5%). Expansive delusions are rare in drug-naïve probable AD patients. Compared with paranoid delusions, misidentification and mixed delusions appeared at a later stage, and were associated with greater cognitive impairment. Mixed delusions were associated with hallucinations. CONCLUSIONS: This study showed that delusions are associated with global cognitive dysfunction. Although paranoid delusions are the most common, misidentification and mixed delusions comprised significant portions of delusions in AD patients, and appeared in the later stages of dementia.
