Differential diagnosis between Alzheimer’s disease-related depression and 
pseudo-dementia in depression: A new indication for amyloid-β imaging?

Leonhardi, Jakob; Barthel, Henryk; Speerforck, Sven; Dietzel, Jens; Schroeter, Matthias L.; Saur, Dorothee; Tiepolt, Solveig; Rullmann, Michael; Patt, Marianne; Claßen, Joseph; Schomerus, Georg; Sabri, Osama

doi:10.3233/JAD-215619

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Differential diagnosis between Alzheimer’s disease-related depression and pseudo-dementia in depression: A new indication for amyloid-β imaging?

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Schroeter, Matthias L.
Clinic for Cognitive Neurology, University of Leipzig, Germany;
Department Neurology, MPI for Human Cognitive and Brain Sciences, Max Planck Society;

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Citation

Leonhardi, J., Barthel, H., Speerforck, S., Dietzel, J., Schroeter, M. L., Saur, D., et al. (2022). Differential diagnosis between Alzheimer’s disease-related depression and pseudo-dementia in depression: A new indication for amyloid-β imaging? Journal of Alzheimer's Disease, 88(3), 1029-1035. doi:10.3233/JAD-215619.

Cite as: https://hdl.handle.net/21.11116/0000-000A-A711-6

Abstract

Background: Alzheimer's disease and depression can start with combined cognitive and depressive symptoms [1, 2]. Accurate differential diagnosis is desired to initiate specific treatment.

Objective: We investigated whether amyloid-β PET imaging can discriminate both entities.

Methods: This retrospective observational study included 39 patients (20 female, age = 70±11years) with both cognitive and depressive symptoms who underwent amyloid-β PET imaging and in whom clinical follow-up data was available. Amyloid-β PET was carried out applying [18F]Florbetaben or [11C]PiB. The PET images were analyzed by standardized visual and relative-quantitative evaluation. Based on clinical follow-up (median of 2.4 years [range 0.3 to 7.0 years, IQR = 3.7 years] after amyloid PET imaging which was not considered in obtaining a definite diagnosis), discrimination ability between AD-related depression and pseudo-dementia in depression/depression with other comorbidities was determined.

Results: Visually, all 10 patients with pseudo-dementia in depression and all 15 patients with other depression were rated as amyloid-β-negative; 2 of 14 patients with AD-related depression were rated amyloid-β-negative. ROC curve analysis of the unified composite standardized uptake value ratios (cSUVRs) was able to discriminate pseudo-dementia in depression from AD-related depression with high accuracy (AUC = 0.92). Optimal [18F]Florbetaben discrimination cSUVR threshold was 1.34. In congruence with the visual PET analysis, the resulting sensitivity of the relative-quantitative analysis was 86% with a specificity of 100% .

Conclusion: Amyloid-β PET can differentiate AD-related depression and pseudo-dementia in depression. Prospective clinical studies are warranted to confirm this result and to potentially broaden the spectrum of clinical applications for amyloid-β PET imaging.