18F-FDG Is a Superior Indicator of Cognitive Performance Compared to 18F-Florbetapir in Alzheimer's Disease and Mild Cognitive Impairment Evaluation: A Global Quantitative Analysis

J Alzheimers Dis. 2019;70(4):1197-1207. doi: 10.3233/JAD-190220.


Background: 18F-Fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) and 18F-florbetapir PET are approved neuroimaging biomarkers for the Alzheimer's disease (AD) and mild cognitive impairment (MCI).

Objectives: This study aims to compare the efficacy of 18F-FDG and 18F-florbetapir PET at evaluating the cognitive performance of patients with AD, MCI, and normal controls (NC).

Methods: 63 subjects (36 male/27 female, mean age = 68.3) including 19 AD, 23 MCI, and 21 NC underwent 18F-FDG and 18F-florbetapir PET imaging. A global quantification approach was applied on supra-tentorial, frontal, parieto-occipital, temporal, and cerebellar brain regions by calculating the global SUVmean ratios (GSUVr) as the weighted average of all regional SUVmean. 18F-FDG and 18F-florbetapir GSUVr of each region were subsequently correlated with the Mini-Mental State Examination (MMSE).

Results: Subjects were studied in five categories as NC, MCI patients, AD patients, MCI and AD patients grouped together (MCI/AD), and a group including all the subjects (NC/MCI/AD). Both 18F-FDG and 18F-florbetapir could successfully detect subjects with dementia (p < 0.001). Studied in all regions and groups, the correlation analysis of 18F-FDG GSUVr with MMSE scores was significant in more regions and groups compared to that of 18F-florbetapir. We also demonstrated that the correlation of 18F-FDG GSUVr with MMSE is stronger than that of 18F-florbetapir in the supra-tentorial and temporal regions.

Conclusions: This study reveals how 18F-FDG-PET global quantification is a superior indicator of cognitive performance in AD and MCI patients compared to 18F-florbetapir PET. Accordingly, we still recommend 18F-FDG-PET over amyloid imaging in the evaluation for AD and MCI.

Keywords: 18F-FDG; Alzheimer’s disease; Mini-Mental State Examination; amyloid-β protein; florbetapir; mild cognitive impairment; positron emission tomography.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Alzheimer Disease / diagnostic imaging*
  • Alzheimer Disease / metabolism*
  • Alzheimer Disease / psychology
  • Aniline Compounds / metabolism*
  • Cognitive Dysfunction / diagnostic imaging*
  • Cognitive Dysfunction / metabolism*
  • Cognitive Dysfunction / psychology
  • Ethylene Glycols / metabolism*
  • Female
  • Fluorine Radioisotopes / metabolism
  • Fluorodeoxyglucose F18 / metabolism*
  • Humans
  • Male
  • Mental Status and Dementia Tests
  • Middle Aged
  • Positron-Emission Tomography / methods
  • Radiopharmaceuticals / metabolism


  • Aniline Compounds
  • Ethylene Glycols
  • Fluorine Radioisotopes
  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18
  • florbetapir