Brain Amyloid and the Transition to Dementia in Down Syndrome

INTRODUCTIONDown syndrome (DS) is associated with elevated risk for Alzheimers disease (AD) due to beta amyloid (A{beta}) lifelong accumulation. We hypothesized that the spatial distribution of brain A{beta} predicts future dementia conversion in individuals with DS. METHODSWe acquired 18F-Florbetapir PET scans from 19 nondemented individuals with DS at baseline and monitored them for four years, with five individuals transitioning to dementia. Machine learning classification determined features on 18F-Florbetapir standardized uptake value ratio (SUVR) maps that predicted transition. RESULTSIn addition to "AD signature" regions including the inferior parietal cortex, temporal lobes, and the cingulum, we found that A{beta} cortical binding in the prefrontal and superior frontal cortices distinguished subjects who transitioned to dementia. Classification did well in predicting transitioners. DISCUSSIONOur study suggests that specific regional profiles of brain amyloid in older adults with DS may predict cognitive decline and are informative in evaluating the risk for dementia. HighlightsO_LIRegional [18F]-Florbetapir PET predicts future transition to dementia in Downs Syndrome. C_LIO_LIIncreased amyloid in prefrontal, inferior parietal, superior frontal, rostral middle frontal, and posterior cingulate cortices detect transitioiners, with prefrontal and superior frontal being best overall. C_LIO_LIAmyloid PET-based classification able to discriminate between transitioners and non-transitioners. C_LI