Early cerebral amyloid- β accumulation and hypermetabolism are associated with subtle cognitive deficits before accelerated cerebral atrophy

Aims Alzheimer’s disease (AD) is characterized by the accumulation of amyloid beta (A β ) in the brain. The deposition of A β is believed to initiate a detrimental cascade, including cerebral hypometabolism, accelerated brain atrophy, and cognitive problems—ultimately resulting in AD. However, the timing and causality of the cascade resulting in AD are not yet fully established. Therefore, we examined whether early A β accumulation affects cerebral glucose metabolism, atrophy rate, and age-related cognitive decline before the onset of neurodegenerative disease. Methods Participants from the Metropolit 1953 Danish Male Birth Cohort underwent brain positron emission tomography (PET) imaging using the radiotracers [ 11 C]Pittsburgh Compound-B (PiB) ( N = 70) and [ 18 F]Fluorodeoxyglucose (FDG) ( N = 76) to assess cerebral A β accumulation and glucose metabolism, respectively. The atrophy rate was calculated from anatomical magnetic resonance imaging (MRI) scans conducted presently and 10 years ago. Cognitive decline was examined from neurophysiological tests conducted presently and ten or 5 years ago. Results Higher A β accumulation in AD-critical brain regions correlated with greater visual memory decline ( p = 0.023). A β accumulation did not correlate with brain atrophy rates. Increased cerebral glucose metabolism in AD-susceptible regions correlated with worse verbal memory performance ( p = 0.040). Conclusions A β accumulation in known AD-related areas was associated with subtle cognitive deficits. The association was observed before hypometabolism or accelerated brain atrophy, suggesting that A β accumulation is involved early in age-related cognitive dysfunction. The association between hypermetabolism and worse memory performance may be due to early compensatory mechanisms adapting for malfunctioning neurons by increasing metabolism.