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Brain metabolism was assessed using subject residual profile (SRP) and standardized uptake value ratio (SUVR).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      Compared to AD\n                      <jats:sup>SAA\u2212<\/jats:sup>\n                      , AD\n                      <jats:sup>SAA+<\/jats:sup>\n                      showed putamen SRP hypermetabolism and middle occipital gyrus (MOG) SUVR hypometabolism. SAA positivity correlated with putamen SRP hypermetabolism independently of pTau\n                      <jats:sub>181<\/jats:sub>\n                      \/amyloid beta 42 (A\u03b2\n                      <jats:sub>42<\/jats:sub>\n                      ). Its interaction with pTau\n                      <jats:sub>181<\/jats:sub>\n                      \/A\u03b2\n                      <jats:sub>42<\/jats:sub>\n                      influenced MOG SUVR, showing increased MOG SUVR with higher pTau\n                      <jats:sub>181<\/jats:sub>\n                      \/A\u03b2\n                      <jats:sub>42<\/jats:sub>\n                      in AD\n                      <jats:sup>SAA+<\/jats:sup>\n                      . Putamen SRP hypermetabolism predicted faster cognitive decline and greater variability in both groups. MOG SUVR hypometabolism correlated with them only in AD\n                      <jats:sup>SAA\u2212<\/jats:sup>\n                      . Adding putamen SRP hypermetabolism to models, including SAA positivity and AD signature hypometabolism, improved the prediction of cognitive decline\/variability, whereas MOG SUVR did not.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DISCUSSION<\/jats:title>\n                    <jats:p>Putaminal hypermetabolism may serve as a robust metabolic marker of LBD co\u2010pathology in AD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Highlights<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>LB co\u2010pathology in AD alters regional brain metabolism.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>SRP analyses capture putaminal hypermetabolism for SAA positivity.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>SUVR analyses emphasize occipital hypometabolism for SAA positivity.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Occipital metabolism correlates positively with AD severity in mixed AD\u2010LB.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Putaminal, not occipital, metabolism predicts cognitive change over AD\u2010related metabolism and SAA.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  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