Predicting long-term clinical stability in amyloid-positive subjects by FDG-PET

Imaging biomarkers can be used to screen participants for Alzheimer's disease clinical trials. To test the predictive values in clinical progression of neuropathology change (amyloid-PET) or brain metabolism as neurodegeneration biomarker ([18F]FDG-PET), we evaluated data from N = 268 healthy controls and N = 519 mild cognitive impairment subjects. Despite being a significant risk factor, amyloid positivity was not associated with clinical progression in the majority (≥60%) of subjects. Notably, a negative [18F]FDG-PET scan at baseline strongly predicted clinical stability with high negative predictive values (>0.80) for both groups. We suggest [18F]FDG-PET brain metabolism or other neurodegeneration measures should be coupled to amyloid-PET to exclude clinically stable individuals from clinical trials.