The A/T/N model applied through imaging biomarkers in a memory clinic

Alessandra Dodich, Aline Mendes, Frédéric Assal, Christian Chicherio, Barinjaka Rakotomiaramanana, Paulina Andryszak, Cristina Festari, Federica Ribaldi, Max Scheffler, Roger Schibli, Adam J Schwarz, Dina Zekry, Karl-Olof Lövblad, Marina Boccardi, Paul G Unschuld, Gabriel Gold, Giovanni B Frisoni, Valentina Garibotto

Research output: Contribution to journalArticlepeer-review


PURPOSE: The A/T/N model is a research framework proposed to investigate Alzheimer's disease (AD) pathological bases (i.e., amyloidosis A, neurofibrillary tangles T, and neurodegeneration N). The application of this system on clinical populations is still limited. The aim of the study is to evaluate the topography of T distribution by 18F-flortaucipir PET in relation to A and N and to describe the A/T/N status through imaging biomarkers in memory clinic patients. METHODS: Eighty-one patients with subjective and objective cognitive impairment were classified as A+/A- and N+/N- through amyloid PET and structural MRI. Tau deposition was compared across A/N subgroups at voxel level. T status was defined through a global cut point based on A/N subgroups and subjects were categorized following the A/T/N model. RESULTS: A+N+ and A+N- subgroups showed higher tau burden compared to A-N- group, with A+N- showing significant deposition limited to the medial and lateral temporal regions. Global cut point discriminated A+N+ and A+N- from A-N- subjects. On A/T/N classification, 23% of patients showed a negative biomarker profile, 58% fell within the Alzheimer's continuum, and 19% of the sample was characterized by non-AD pathologic change. CONCLUSION: Medial and lateral temporal regions represent a site of significant tau accumulation in A+ subjects and possibly a useful marker of early clinical changes. This is the first study in which the A/T/N model is applied using 18F-flortaucipir PET in a memory clinic population. The majority of patients showed a profile consistent with the Alzheimer's continuum, while a minor percentage showed a profile suggestive of possible other neurodegenerative diseases. These results support the applicability of the A/T/N model in clinical practice.
Original languageEnglish
Number of pages9
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
Publication statusE-pub ahead of print - 2019


  • 18F-flortaucipir
  • A/T/N model
  • Alzheimer’s disease
  • PET


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