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This case study presents a 70-year-old architect experiencing progressive memory difficulties and behavioral changes, despite remaining independent in daily life. Neuropsychological assessment identified mild episodic memory deficits, leading to a diagnosis of single-domain mild cognitive impairment. Brain MRI showed mild subcortical atrophy, while [18F]FDG-PET revealed frontotemporal hypometabolism, initially suggestive of frontotemporal dementia. However, amyloid-PET detected significant cortical amyloid accumulation, and tau-PET demonstrated widespread neurofibrillary pathology, with significant deposition in frontal regions, supporting a diagnosis of MCI due to Alzheimer’s disease. The case underscores the diagnostic challenges posed by atypical clinical and metabolic patterns in neurodegeneration. [18F]FDG-PET patterns of hypometabolism can sometimes be atypical, making it difficult to establish the correct etiological diagnosis in patients with cognitive impairment. Amyloid-PET and tau-PET, as core biomarkers, provide critical information for identifying Alzheimer’s-related pathology and its topography, improving diagnostic accuracy. This case highlights the importance of integrating multimodal imaging for precise etiological diagnosis in patients with cognitive impairment.

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Case 4: Differentiating AD from Non-AD Pathology with Molecular Imaging (FDG, Amyloid, and Tau PET)

  • 章节

  • 发表日期：

    2025年

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  • Gregory Mathoux,
  • Cecilia Boccalini,
  • Giovanni B. Frisoni,
  • Valentina Garibotto

摘要

This case study presents a 70-year-old architect experiencing progressive memory difficulties and behavioral changes, despite remaining independent in daily life. Neuropsychological assessment identified mild episodic memory deficits, leading to a diagnosis of single-domain mild cognitive impairment. Brain MRI showed mild subcortical atrophy, while [18F]FDG-PET revealed frontotemporal hypometabolism, initially suggestive of frontotemporal dementia. However, amyloid-PET detected significant cortical amyloid accumulation, and tau-PET demonstrated widespread neurofibrillary pathology, with significant deposition in frontal regions, supporting a diagnosis of MCI due to Alzheimer’s disease. The case underscores the diagnostic challenges posed by atypical clinical and metabolic patterns in neurodegeneration. [18F]FDG-PET patterns of hypometabolism can sometimes be atypical, making it difficult to establish the correct etiological diagnosis in patients with cognitive impairment. Amyloid-PET and tau-PET, as core biomarkers, provide critical information for identifying Alzheimer’s-related pathology and its topography, improving diagnostic accuracy. This case highlights the importance of integrating multimodal imaging for precise etiological diagnosis in patients with cognitive impairment.