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Brain 18FDG-PET pattern in patients with alcohol-related cognitive impairment

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Brain positron emission tomography using 18F-fluorodeoxyglucose (18FDG-PET) provides a metabolic assessment of brain function that is useful for differential diagnosis among several neurodegenerative diseases manifested by cognitive impairment (CI). The purpose of the study is to describe the pattern of 18FDG-PET abnormalities in patients with CI related to alcohol use disorder.

Methods

Patients admitted to the addiction medicine department of a university hospital in Paris between January 2017 and October 2018 with a confirmed diagnosis of alcohol-related cognitive impairment (ARCI) or Wernicke encephalopathy (WE) were included. Brain 18FDG-PET uptake was measured after at least 1 month of monitored abstinence from alcohol. Standardized uptake values were obtained for 13 regions of interest (ROI) and normalized to the pons. Individual patients’ ROI Z-scores were calculated from healthy sex- and age-matched controls provided by Cortex ID software.

Results

Twenty-five patients were included in the analysis (20 males and 5 females; mean age 57.6 years (45–76 years old)). The group consisted of 19 ARCI and 6 WE cases. The mean hypometabolism was most severe in the prefrontal medial cortex (PFM) (− 2.80 (± 1.30)), the prefrontal lateral cortex (− 2.20 (± 1.35)), and the anterior cingulate cortex (− 2.24 (± 1.19)). Hypometabolism (Z-score < − 2) was most frequent in the PFM (72.0% of the sample, N = 18). Other regions were also affected (with 5.32/13 hypometabolic ROIs on average (SD = 4.16, range 0–13)). The Z-scores in the 13 ROIs did not differ significantly between the ARCI and WE patients (p ≥ 0.05).

Conclusions

Predominant prefrontal and cingulate cortex hypometabolism was the most frequent brain 18FDG-PET pattern in our sample of patients with ARCI and WE.

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Acknowledgments

The authors would like to thank Eric Hispard (Fernand-Widal Hospital, APHP, Paris, France), François Naccache (Saint-Louis Hospital, APHP, Paris, France), Philippe Michaud (Unité Serge Korsakoff, Villeneuve-La-Garenne, France), Dorothée Lecallier (Clinique des Epinettes, Paris, France), Stéphane Levy (Goüin Hospital, Clichy, France), Pierre Polomeni (Addictology Department, René-Muret Hospital, APHP, Sevran, France), and the ResAlCog Network. In addition, the authors would like to thank the editors of Nature Research Editing Service for their professional review of the English language.

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Authors and Affiliations

  1. Département de Psychiatrie et de Médecine Addictologique, Groupe Hospitalier Saint-Louis Lariboisière Fernand-Widal, Hôpital Fernand Widal, Paris, France

    Virgile Clergue-Duval, Frank Questel, Julien Azuar, Jihed Amami, Alexandra Dereux, Thomas Barré, Frank Bellivier & Florence Vorspan

  2. Inserm UMRS-1144 Optimisation thérapeutique en neuropsychopharmacologie, Université de Paris, Paris, France

    Virgile Clergue-Duval, Frank Questel, Julien Azuar, Claire Paquet, Emmanuel Cognat, Alexandra Dereux, Frank Bellivier, Karim Farid & Florence Vorspan

  3. Faculté de Médecine, Université de Paris, 75475, Paris Cedex 10, France

    Virgile Clergue-Duval, Frank Bellivier & Florence Vorspan

  4. APHP, Centre de Neurologie Cognitive, Groupe Hospitalier Saint-Louis Lariboisière Fernand-Widal, Paris, France

    Claire Paquet & Emmanuel Cognat

  5. Service de médecine nucléaire, Centre Cardiologique du Nord, St-Denis, France

    Mathieu Queneau

  6. Service de médecine nucléaire, CHU Martinique, Fort de France, Martinique, FWI, France

    Karim Farid

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  1. Virgile Clergue-Duval
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Correspondence to Virgile Clergue-Duval.

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Conflict of interest

Florence Vorspan reports grants from Fondation Pour la Recherche en Alcoologie and congress fees from Camurus AB Pharmaceutical, outside the submitted work. Julien Azuar reports grants from Fondation Pour la Recherche en Alcoologie, outside the submitted work. Frank Bellivier has received honoraria or research or educational conference grants from Bristol-Myers Squibb, Otsuka, Eli Lilly & Co., Servier, Takeda, Sanofi Aventis, Lundbeck, AstraZeneca, and the European Space Agency and has received peer review research funding from the Ministry of Research, Assistance Publique–Hôpitaux de Paris, the National Institute for Research (INSERM), and the NARSAD, outside the submitted work. Claire Paquet is a member of the International Advisory Boards of Lilly, is a consultant with Fujiribio, Alzohis, Neuroimmune, and Gilead, and is involved as an investigator in several clinical trials for Roche, Esai, Lilly, Biogen, Astra-Zeneca, Lundbeck, and Neuroimmune, outside the submitted work. Emmanuel Cognat is involved as an investigator in several clinical trials for Roche, Esai and Biogen, outside the submitted work. Virgile Clergue-Duval, Frank Questel, Karim Farid, Mathieu Queneau, Jihed Amami, Alexandra Dereux, and Thomas Barré have no conflict of interest to disclose.

Ethical approval

The study was conducted in accordance with the 1964 Helsinki declaration, its later amendments or comparable ethical standards, and to French laws on biomedical research (Loi Jardé 2014, décrets d’application 2017).

Informed consent

Because those data were collected during care, because all patients were informed that their data could be used for research purposes, and because none of the patients or their legal representatives expressed opposition, we did not obtain formal written consent. Furthermore, our hospital has a specific authorization Number 2017–013 given on 19 January 2017 by the CNIL (Commission Nationale Informatique et Liberté, French national board for information systems and freedom) for the analysis of data collected during routine care.

The legal representative of the patient whose brain 18FDG-PET is shown in Figs. 2 and 3 has specifically agreed to the use of the images.

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Karim Farid and Florence Vorspan are joint last authors

This article is part of the Topical Collection on Neurology

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Clergue-Duval, V., Questel, F., Azuar, J. et al. Brain 18FDG-PET pattern in patients with alcohol-related cognitive impairment. Eur J Nucl Med Mol Imaging 47, 281–291 (2020). https://doi.org/10.1007/s00259-019-04487-1

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