TY - JOUR T1 - Metabolic brain changes across different levels of cognitive impairment in ALS: a <sup>18</sup>F-FDG-PET study JF - Journal of Neurology, Neurosurgery &amp; Psychiatry JO - J Neurol Neurosurg Psychiatry SP - 357 LP - 363 DO - 10.1136/jnnp-2020-323876 VL - 92 IS - 4 AU - Antonio Canosa AU - Cristina Moglia AU - Umberto Manera AU - Rosario Vasta AU - Maria Claudia Torrieri AU - Vincenzo Arena AU - Fabrizio D'Ovidio AU - Francesca Palumbo AU - Jean Pierre Zucchetti AU - Barbara Iazzolino AU - Laura Peotta AU - Andrea Calvo AU - Marco Pagani AU - Adriano Chiò Y1 - 2021/04/01 UR - http://jnnp.bmj.com/content/92/4/357.abstract N2 - Objective To identify the metabolic changes related to the various levels of cognitive deficits in amyotrophic lateral sclerosis (ALS) using 18F-2-fluoro-2-deoxy-D-glucose positron emission tomography (18F-FDG-PET) imaging.Methods 274 ALS patients underwent neuropsychological assessment and brain 18F-FDG-PET at diagnosis. According to the criteria published in 2017, cognitive status was classified as ALS with normal cognition (ALS-Cn, n=132), ALS with behavioural impairment (ALS-Bi, n=66), ALS with cognitive impairment (ALS-Ci, n=30), ALS with cognitive and behavioural impairment (ALS-Cbi, n=26), ALS with frontotemporal dementia (ALS–FTD, n=20). We compared each group displaying some degree of cognitive and/or behavioural impairment to ALS-Cn patients, including age at PET, sex and ALS Functional Rating Scale-Revised as covariates.Results We identified frontal lobe relative hypometabolism in cognitively impaired patients that resulted more extensive and significant across the continuum from ALS-Ci, through ALS-Cbi, to ALS–FTD. ALS–FTD patients also showed cerebellar relative hypermetabolism. ALS-Bi patients did not show any difference compared with ALS-Cn.Conclusions These data support the concept that patients with cognitive impairment have a more widespread neurodegenerative process compared with patients with a pure motor disease: the more severe the cognitive impairment, the more diffuse the metabolic changes. Otherwise, metabolic changes related to pure behavioural impairment need further characterisation. ER -