Asymmetrical Neuroimaging Insights in CSF‐Validated Early‐Onset Alzheimer's: Integrating PET, MRI, and Cognitive Assessment

Abstract Background Early‐onset Alzheimer's disease (EOAD), manifesting before age 65, demands nuanced diagnostic approaches. FDG18‐PET unveils metabolic insights, the MRI scale captures structural changes, and ACE‐R assesses cognitive impairment details. A holistic evaluation enhances diagnostic precision and enriches our understanding of cognitive decline in early‐onset presentations. Method Early‐onset Alzheimer's disease (EOAD), manifesting before age 65, demands nuanced diagnostic approaches. FDG18‐PET unveils metabolic insights, the MRI scale captures structural changes, and ACE‐R assesses cognitive impairment details. A holistic evaluation enhances diagnostic precision and enriches our understanding of cognitive decline in early‐onset presentations. Result Twenty‐two patients (59.1% women) with a mean age at diagnosis of 55.3 (±6.52 StD) years participated. The mean disease duration was 5.06 (±2.95 StD) years. All of the patients were right‐handed. The mean Aβ42 and phos‐tau were 392.49 (±200.13 StD) and 130.93 (±142.56 StD) pg/ml, respectively. No significant difference was found between the right and left insular cortex in PET, and no statistically significant asymmetry was found between VAS scores in MRI (p > 0.05). There was no correlation between PET index with CSF Aβ42 and and phos‐tau values. Conclusion This study underscores notable asymmetries in PET atrophy scores between the corresponding right and left brain regions in Alzheimer's patients. Given that EOAD manifests with atypical clinical symptoms, and all participants in this study exhibited left‐hemispheric dominance, the observed metabolic asymmetry, in the absence of a corresponding structural asymmetry, holds clinical significance.