Regional cerebral metabolism in early Alzheimer's disease with clinically significant apathy or depression

Background: Alzheimer's disease (AD) is clinically characterized by cognitive impairment and behavioral disturbances. The aim of the study was to identify regional alterations in brain function associated with neuropsychiatric symptoms in early AD, Methods: Patients underwent measures of cerebral glucose metabolism applying positron emission tomography (PET) and F-18-fluorodeoxyglucose. Neuropsychiatric symptoms were assessed using the Neuropsychiatric Inventory (NPI). Positron emission tomography images qf patients sqffering a neuropsychiatric symptom qf clinical signffiicance (NPI subscore for a specific item greater than or equal to4 points) were compared with the images of patients without the specific symptom under study (NPI subscore for a specific item 0 points). Results: A total of 53 patients with AD (Mini-Mental State Examination [MMSE] 22.5 +/- 2.94 points) entered the study. Of all symptoms, apathy and depression were most frequently encountered. The patient group with apathy (n = 17) revealed significant decreases in left orbitofrontal regions when compared with patients free of apathy. Depression of clinical significance (n = 10) was associated with hypometabolism in dorsolateral prefrontal regions. Conclusions: These findings support the notion that different functional circuits underlie apathy and depression in early AD.