TY - JOUR
T1 - Combination of Structural MRI and FDG-PET of the Brain Improves Diagnostic Accuracy in Newly Manifested Cognitive Impairment in Geriatric Inpatients
AU - Ritter, Kerstin
AU - Lange, Catharina
AU - Weygandt, Martin
AU - Mäurer, Anja
AU - Roberts, Anna
AU - Estrella, Melanie
AU - Suppa, Per
AU - Spies, Lothar
AU - Prasad, Vikas
AU - Steffen, Ingo
AU - Apostolova, Ivayla
AU - Bittner, Daniel
AU - Gövercin, Mehmet
AU - Brenner, Winfried
AU - Mende, Christine
AU - Peters, Oliver
AU - Seybold, Joachim
AU - Fiebach, Jochen B.
AU - Steinhagen-Thiessen, Elisabeth
AU - Hampel, Harald
AU - Haynes, John Dylan
AU - Buchert, Ralph
N1 - Publisher Copyright:
© 2016 - IOS Press and the authors. All rights reserved.
PY - 2016/10/18
Y1 - 2016/10/18
N2 - Background: The cause of cognitive impairment in acutely hospitalized geriatric patients is often unclear. The diagnostic process is challenging but important in order to treat potentially life-threatening etiologies or identify underlying neurodegenerative disease. Objective: To evaluate the add-on diagnostic value of structural and metabolic neuroimaging in newly manifested cognitive impairment in elderly geriatric inpatients. Methods: Eighty-one inpatients (55 females, 81.6±5.5 y) without history of cognitive complaints prior to hospitalization were recruited in 10 acute geriatrics clinics. Primary inclusion criterion was a clinical hypothesis of Alzheimer's disease (AD), cerebrovascular disease (CVD), or mixed ADCVD etiology (MD), which remained uncertain after standard diagnostic workup. Additional procedures performed after enrollment included detailed neuropsychological testing and structural MRI and FDG-PET of the brain. An interdisciplinary expert team established the most probable etiologic diagnosis (non-neurodegenerative, AD, CVD, or MD) integrating all available data. Automatic multimodal classification based on Random Undersampling Boosting was used for rater-independent assessment of the complementary contribution of the additional diagnostic procedures to the etiologic diagnosis. Results: Automatic 4-class classification based on all diagnostic routine standard procedures combined reproduced the etiologic expert diagnosis in 31 of the patients (p=0.100, chance level 25). Highest accuracy by a single modality was achieved by MRI or FDG-PET (both 45, p≤0.001). Integration of all modalities resulted in 76 accuracy (p≤0.001). Conclusion: These results indicate substantial improvement of diagnostic accuracy in uncertain de novo cognitive impairment in acutely hospitalized geriatric patients with the integration of structural MRI and brain FDG-PET into the diagnostic process.
AB - Background: The cause of cognitive impairment in acutely hospitalized geriatric patients is often unclear. The diagnostic process is challenging but important in order to treat potentially life-threatening etiologies or identify underlying neurodegenerative disease. Objective: To evaluate the add-on diagnostic value of structural and metabolic neuroimaging in newly manifested cognitive impairment in elderly geriatric inpatients. Methods: Eighty-one inpatients (55 females, 81.6±5.5 y) without history of cognitive complaints prior to hospitalization were recruited in 10 acute geriatrics clinics. Primary inclusion criterion was a clinical hypothesis of Alzheimer's disease (AD), cerebrovascular disease (CVD), or mixed ADCVD etiology (MD), which remained uncertain after standard diagnostic workup. Additional procedures performed after enrollment included detailed neuropsychological testing and structural MRI and FDG-PET of the brain. An interdisciplinary expert team established the most probable etiologic diagnosis (non-neurodegenerative, AD, CVD, or MD) integrating all available data. Automatic multimodal classification based on Random Undersampling Boosting was used for rater-independent assessment of the complementary contribution of the additional diagnostic procedures to the etiologic diagnosis. Results: Automatic 4-class classification based on all diagnostic routine standard procedures combined reproduced the etiologic expert diagnosis in 31 of the patients (p=0.100, chance level 25). Highest accuracy by a single modality was achieved by MRI or FDG-PET (both 45, p≤0.001). Integration of all modalities resulted in 76 accuracy (p≤0.001). Conclusion: These results indicate substantial improvement of diagnostic accuracy in uncertain de novo cognitive impairment in acutely hospitalized geriatric patients with the integration of structural MRI and brain FDG-PET into the diagnostic process.
KW - Cognitive impairment
KW - geriatric inpatients
KW - magnetic resonance imaging
KW - multimodal classification
KW - positron emission tomography
UR - http://www.scopus.com/inward/record.url?scp=84992110682&partnerID=8YFLogxK
U2 - 10.3233/JAD-160380
DO - 10.3233/JAD-160380
M3 - Article
C2 - 27567842
AN - SCOPUS:84992110682
SN - 1387-2877
VL - 54
SP - 1319
EP - 1331
JO - Journal of Alzheimer's Disease
JF - Journal of Alzheimer's Disease
IS - 4
ER -