Case Report: The Alzheimer's paradox: a clinically stable amnestic syndrome with full biomarker positivity and minimal imaging evidence

Anna-Chloé Balageas; Johnny Vercouillie; Nicolas Arlicot; Anne-Claire Dupont; Maria-Joao Santiago Ribeiro

doi:10.3389/fmed.2025.1653232

Case Report: The Alzheimer's paradox: a clinically stable amnestic syndrome with full biomarker positivity and minimal imaging evidence

Front Med (Lausanne). 2025 Aug 19:12:1653232. doi: 10.3389/fmed.2025.1653232. eCollection 2025.

Authors

Anna-Chloé Balageas¹, Johnny Vercouillie², Nicolas Arlicot^{2

3}, Anne-Claire Dupont³, Maria-Joao Santiago Ribeiro^{2

4}

Affiliations

¹ Centre Mémoire Ressources et Recherche CHU Tours, Tours, France.
² UMR, iBrain, Université de Tours, Inserm, Tours, France.
³ Radiopharmacy, CHU Tours, Tours, France.
⁴ Nuclear Medicine, CHU Tours, Tours, France.

Abstract

We report the case of a 75-year-old patient with a clinically isolated and stable amnestic syndrome over fifteen years, despite a cerebrospinal fluid (CSF) profile strongly consistent with Alzheimer's disease (AD). Serial PET imaging over two years showed only limited amyloid accumulation, no significant tau deposition, no hypometabolism, and no neuroinflammation. This case illustrates a striking dissociation between biomarker positivity and clinical progression, raising important questions about individual resilience and the prognostic value of AD biomarkers in isolation.

Keywords: Alzheimer; MCI; PET imaging; biomarker; neuroimaging.

Publication types

Case Reports