Application of an amyloid and tau classification system in subcortical vascular cognitive impairment patients

Objective: To apply an AT (Aβ/tau) classification system to subcortical vascular cognitive impairment (SVCI) patients following recently developed biomarker-based criteria of Alzheimer’s disease (AD), and to investigate its clinical significance. Methods: We recruited 60 SVCI patients who underwent the neuropsychological tests, brain MRI, and ¹⁸F-florbetaben and ¹⁸F-AV1451 PET at baseline. As a control group, we further recruited 27 patients with AD cognitive impairment (ADCI; eight Aβ PET-positive AD dementia and 19 amnestic mild cognitive impairment). ADCI and SVCI patients were classified as having normal or abnormal Aβ (A−/A+) and tau (T−/T+) based on PET results. Across the three SVCI groups (A−, A+T−, and A+T+SVCI), we compared longitudinal changes in cognition, hippocampal volume (HV), and cortical thickness using linear mixed models. Results: Among SVCI patients, 33 (55%), 20 (33.3%), and seven (11.7%) patients were A−, A+T−, and A+T+, respectively. The frequency of T+ was lower in A+SVCI (7/27, 25.9%) than in A+ADCI (14/20, 70.0%, p = 0.003) which suggested that cerebral small vessel disease affected cognitive impairments independently of A+. A+T−SVCI had steeper cognitive decline than A−SVCI. A+T+SVCI also showed steeper cognitive decline than A+T−SVCI. Also, A+T−SVCI had steeper decrease in HV than A−SVCI, while cortical thinning did not differ between the two groups. A+T+SVCI had greater global cortical thinning compared with A+T−SVCI, while declines in HV did not differ between the two groups. Conclusion: This study showed that the AT system successfully characterized SVCI patients, suggesting that the AT system may be usefully applied in a research framework for clinically diagnosed SVCI.