Prediction of Amyloid Positivity in Patients with Subcortical Vascular Cognitive Impairment

Article type: Research Article

Authors: Moon, Hasom^{a; g} | Ham, Hongki^{a; b; d; e} | Yun, Jihwan^{a; h} | Shin, Daeun^a | Lee, Eun Hye^a | Kim, Hee Jin^{a; b; c; e} | Seo, Sang Won^{a; b; c; e} | Na, Duk L.^{a; b; c; f; *} | Jang, Hyemin^{a; b; c; g; *}

Affiliations: [a] Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea | [b] Neuroscience Center, Samsung Medical Center, Seoul, South Korea | [c] Samsung Alzheimer’s Convergence Research Center, Samsung Medical Center, Seoul, South Korea | [d] Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, South Korea | [e] Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea | [f] Happymind Clinic, Seoul, South Korea | [g] Department of Neurology, Seoul National University Hospital, Seoul National University School of Medicine, Seoul, South Korea | [h] Department of Neurology, Soonchunhyang University Bucheon Hospital, Gyeonggi-do, South Korea

Correspondence: [*] Correspondence to: Duk L. Na, MD, PhD, Happymind Clinic, Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea, Tel.: +82 2 3410 1233, E-mail: dukna@naver.com and Hyemin Jang, MD, PhD, Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea. Tel.: +82 2 2072 4802, E-mail: hmjang57@gmail.com.

Abstract: Background:Amyloid-β (Aβ) commonly coexists and impacts prognosis in subcortical vascular cognitive impairment (SVCI). Objective:This study aimed to examine the differences in clinical and neuroimaging variables between Aβ-positive and Aβ-negative SVCI and to propose a prediction model for Aβ positivity in clinically diagnosed SVCI patients. Methods:A total of 130 patients with SVCI were included in model development, and a separate cohort of 70 SVCI patients was used in external validation. The variables for the prediction model were selected by comparing the characteristics of the Aβ-negative and Aβ-positive SVCI groups. The final model was determined using a stepwise method. The model performance was evaluated using the receiver operating characteristic (ROC) curve and a calibration curve. A nomogram was used for visualization. Results:Among 130 SVCI patients, 70 (53.8%) were Aβ-positive. The Aβ-positive SVCI group was characterized by older age, tendency to be in the dementia stage, a higher prevalence of APOE ɛ4, a lower prevalence of lacune, and more severe medial temporal atrophy (MTA). The final prediction model, which excluded MTA grade following the stepwise method for variable selection, demonstrated good accuracy in distinguishing between Aβ-positive and Aβ-negative SVCI, with an area under the curve (AUC) of 0.80. The external validation demonstrated an AUC of 0.71. Conclusions:The findings suggest that older age, dementia stage, APOE ɛ4 carrier, and absence of lacunes may be predictive of Aβ positivity in clinically diagnosed SVCI patients.

Keywords: Alzheimer’s disease, amyloid-β , dementia, mild cognitive impairment, subcortical vascular cognitive impairment

DOI: 10.3233/JAD-240196

Journal: Journal of Alzheimer's Disease, vol. 99, no. 3, pp. 1117-1127, 2024