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LETTER TO THE EDITOR
Dementia and Neurocognitive Disorders 2018: 17: 4: 174-175

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A Case of Early Onset Alzheimer's Disease Diagnosed by 18F Flutemetamol PET Image
Jeong-Hoon Kim,1 Eun-Jeong Lee,2 Sang-Soon Park,1 Jae-Hyeok Heo 1
1 Department of Neurology, Seoul Medical Center, Seoul, Korea 2 Department of Nuclear Medicine, Seoul Medical Center, Seoul, Korea
A Case of Early Onset Alzheimer's Disease Diagnosed by 18F Flutemetamol PET Image
Jeong-Hoon Kim,1 Eun-Jeong Lee,2 Sang-Soon Park,1 Jae-Hyeok Heo 1
1 Department of Neurology, Seoul Medical Center, Seoul, Korea 2 Department of Nuclear Medicine, Seoul Medical Center, Seoul, Korea
Early-onset Alzheimer's disease (EOAD) have difficulty in making accurate clinical diagnosis,
its patients are more likely to show atypical symptoms such as visual, language, and
behavioral abnormalities compared to older Alzheimer's disease (AD) patients with typical
memory impairment.1
Recently, several fluorine-18-labeled positron emission tomography
(
18F PET) tracers have been developed and used to enable pathological diagnosis of AD.1
A 51-year-old female patient visited our dementia clinic with a gradual cognitive decline. The
patient could not operate properly due to difficulties in using mobile phone and TV remote
control, and could confuse one for the other. She often forgot where she put her clothes or
things in general and could not remember her children's birthday. Also, she had already left
the company she was working for. Her consciousness was clear and there was no abnormality
in cranial nerve examination. Her motor, sensory, and deep tendon reflexes were all normal
in limbs.
The patient was a college graduate. She scored 18 points in her Korean version of Mini Mental
Status Examination and 2 points in Clinical Dementia Rating. There was no evidence of
depression at the short version of the Geriatric Depression Scale. However, severe functional
impairment was found during the Korean-Boston Naming Test, language memory, and
frontal/executive functions. On the blood test, thyroid function tests, syphilis, vitamin B 12
and folate levels were normal and the apolipoprotein E genotype was 3/3. Magnetic resonance
imaging revealed a slight atrophy of the medial temporal lobe.
The patient was judged to be a candidate for amyloid PET examination of the amyloid
imaging taskforce (AIT).2
The 18F flutemetamol PET was performed and amyloid deposits
were observed in various regions of the brain cortex (Fig. 1).
The patient was prescribed donepezil after diagnosis by EOAD.
Clinically, it is difficult to accurately diagnose EOAD because they have atypical clinical
characteristics such as vision or speech difficulties, behavioral changes, and difficulty in
using the tool.1
In addition, in studies comparing EOAD and late-onset AD, apraxia and
visuospatial dysfunction have been reported to be early symptoms of EOAD.3
The exact
diagnosis of EOAD is very important considering the different treatment methods and
prognosis according to the cause of dementia.
For the 51-year-old female patient, she had difficulties in using the mobile phone and the
remote control as well as distinguishing them. Therefore, this could be the early symptom of
EOAD as mentioned above. However, due to her age and her progressiveness, the patient and
her family could not accept it and wanted more accurate tests. Therefore, amyloid PET test
was performed to make a pathological diagnosis. Amyloid PET examination revealed amyloid
pathology, confirming EOAD, and patient and her family were cooperating and actively
involved in the treatment of AD.
Recently, several 18F PET tracers, including 18F flutemetamol, have been used to allow noninvasive identification of amyloid pathology.1
As a result, these pathological biomarkers are
increasingly being used clinically and are included in research criteria for AD. However, the
level of amyloid beta is increased not only in AD but also in the elderly. The price is high
and there are limitations such as the limited number of institutions that can perform such
tests. Therefore, when choosing patients for amyloid PET examinations, it may be advisable
to follow the guidance from the AIT.2
In this study, it was concluded that the condition of
dementia patients with early age of onset with atypical clinical course was satisfactory.
Although the costs and equipment problems of Amyloid PET testing have not yet been
resolved, choosing a candidate carefully according to the guidelines will be a great help for
the diagnosis, treatment, and prognosis of AD.
Key Words:
대한치매학회지 (Dementia and Neurocognitive Disorders)

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