Florbetapir-PET β-amyloid imaging and associated neuropsychological trajectories in survivors of critical illness: A case series

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Purpose:Cognitive impairment resembling Alzheimer's disease is common in survivors of critical illness. We hypothesized that Intensive Care Unit (ICU) survivors with cognitive impairment would have significant amyloid and designed a pilot study to explore this relationship.Materials and methods:A pilot, case series of a convenience sample of 14 adult medical and surgical ICU survivors, in a clinical neuroradiology clinic. Patients underwent cognitive testing at 3 months, 1 year, 4 years, and 6 years after hospital discharge with the Repeatable Battery for the Assessment of Neuropsychological Status. They received a single PET scan using amyloid PET imaging (florbetapir F18) 2 to 4 years after their ICU stay.Results:Amyloid (defined as a Standard Uptake Value ratio or SUVr >1.10) was present in 2 of 14 (14%) individuals, both of whom demonstrated significant cognitive impairment yet no consistent decline over time. Of the 6 impaired patients (RBANS < 78), 4 (66.7%) were amyloid negative.Conclusions:It is feasible to assess ICU survivors with amyloid imaging. In this small sample, most patients with cognitive impairment were negative on amyloid PET imaging, which raises the possibility that ICU survivors may experience a unique form of dementia not driven by an amyloid related mechanism.HighlightsCerebral amyloid imaging can be done feasibly and safely with medically ill, cognitively impaired ICU survivors.Cerebral amyloid does not appear to be abnormally high in cognitively impaired survivors of the ICU, suggesting that non-amyloid related mechanisms may be contributing to such impairment.Regardless of age and amyloid status, cognitive decline up to 6 years after discharge is common.Cognitive training may have the potential to improve the impairment experienced by ICU survivors, as this impairment is likely not typically reflective of Alzheimer's disease.

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