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Alzheimer’s Plaques Seen in PET Brain Scans Could Identify Future Cognitive Decline

By MedImaging International staff writers
Posted on 23 Jul 2012

Image: PET images using florbetapir dye to highlight beta-amyloid plaques show (A), a cognitively normal subject; (B) an amyloid-positive patient with Alzheimer’s disease; (C) a patient with mild cognitive impairment; and (D) a patient with mild cognitive impairment who progressed to dementia during the study (Photo courtesy of Neurology).

Among patients with mild or no cognitive impairment, brain scans using a new radioactive dye can identify early indications of Alzheimer’s disease (AD) that may forecast future decline, according to findings from a multicenter study.

The new research was published online July 11, 2012, in the journal Neurology, the medical journal of the American Academy of Neurology. It expands on smaller studies revealing that early detection of hallmark plaques could be a predictive tool to help guide care and treatment decisions for patients with AD. “Even at a short follow-up of 18 months we can see how the presence of amyloid plaques affects cognitive function,” said P. Murali Doraiswamy, MD, professor of psychiatry at Duke who co-led the study with R. Edward Coleman, MD, professor of radiology at Duke University (Durham, NC, USA). “Most people who come to the doctor with mild impairment really want to know the short-term prognosis and potential long-term effect.”

Dr. Doraiswamy noted that such information also has some drawbacks. There is no cure for AD, which afflicts 5.4 million people in the United States and is the sixth-leading cause of death among US adults alone. But, he said, numerous drugs are being investigated, and identifying earlier disease would improve research into their potential benefits and has enabled new advances, while also enhancing care and treatment of current patients.

In the study, 151 people who had enrolled in a multicenter test of a new radioactive dye called florbetapir (Amyvid) were recruited to participate in a 36-month analysis. Of those participants, 69 had normal cognitive function at the start of the study, 51 had been diagnosed with mild impairment, and 31 had Alzheimer’s dementia. All completed cognitive tests and underwent brain scanning using positron emission tomography (PET) imaging. The technology utilizes radioactive tracers devised to highlight specific tissue to create a three-dimensional (3D) image of an organ or a biologic function.

The dye used in the study, florbetapir, was recently approved by the US Food and Drug Administration (FDA) for PET imaging of the brain to estimate beta-amyloid plaque density in patients who are being evaluated for cognitive impairment. It binds to the amyloid plaques that characterize AD, providing a look into the brain to see if the plaques have formed, and how extensively.

Patients in the study were reassessed with additional cognitive exams at 18 months and 36 months. At the 18-month point, patients with mild cognitive impairment who had PET evidence of plaque at the trial’s initiated worsened to a great level on cognitive tests than patients who had no evidence of plaque at the trial’s start. Twenty-nine percent of the plaque-positive patients in this group developed AD dementia, compared to 10% who started with no plaque.

Cognitively normal patients with a plaque-positive PET scan at the start of the study also showed more mental decline at 18 months compared to those who were negative for plaque. The study additionally found that people with negative scans reversed from minimally impaired to normal more often than people with positive PET scan, suggesting test anxiety or concentration problems could have affected their initial performance.

“For the most part we have been blind about who would progress and who wouldn't, so this approach is a step toward having a biomarker that predicts risk of decline in people who are experiencing cognitive impairment,” Dr. Doraiswamy said.

According to Dr. Doraiswamy, the study’s findings provide early data that needs to be verified by additional research. Final, 36-month data from the study has been completed and will be presented at the Alzheimer’s Association International Conference held July 2012 in Vancouver, Canada. Dr. Doraiswamy also warned that florbetapir is currently not approved to predict the development of dementia or other neurologic disorders and stressed that it should not be used as a screening tool in otherwise normal or minimally impaired people. Similarly, a positive scan is not necessarily diagnostic for Alzheimer’s by itself.

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61 (105.14259338379): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

62 (508.06999206543): SELECT fid FROM jos_deeppockets WHERE id=294741732 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294741732 AND published='1' LIMIT 1

63 (46.014785766602): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=213 ORDER BY `ordering`

64 (40.054321289062): select jos_twitters.link from jos_twitters where cat=10

65 (28.848648071289): select jos_facebook.link from jos_facebook where cat=10

66 (35.04753112793): select jos_google_plus.link from jos_google_plus where cat=10

67 (38.862228393555): select jos_linkedin.link from jos_linkedin where cat=10

68 (48.87580871582): SELECT fid FROM jos_deeppockets WHERE id=294741732 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294741732 AND published='1' LIMIT 1

69 (34.809112548828): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=213 ORDER BY `ordering`

70 (436.06758117676): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294741732 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (423.90823364258): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294741732 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (96.08268737793): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (77.962875366211): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (43.153762817383): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294741732 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (30.994415283203): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294741732 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (36.001205444336): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (74.148178100586): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (50.067901611328): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (62.942504882812): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (96.797943115234): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741732 AND published='1' LIMIT 1

105 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741732 AND published='1' LIMIT 1

106 (77.009201049805): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294741732 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (101.08947753906): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294741732 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (76.055526733398): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741732 AND published='1' LIMIT 1

109 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741732 AND published='1' LIMIT 1

110 (51.021575927734): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294741732 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (517.84515380859): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294741732 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (744.10438537598): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (430.10711669922): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (185.96649169922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741732 AND published='1' LIMIT 1

115 (101.08947753906): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741732 AND published='1' LIMIT 1

116 (114.91775512695): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741732 AND published='1' LIMIT 1

117 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741732 AND published='1' LIMIT 1

118 (58.889389038086): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741732 AND published='1' LIMIT 1

119 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741732 AND published='1' LIMIT 1

120 (293.01643371582): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

121 (!!!!! 20747.900009155): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

122 (106.0962677002): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741732 AND published='1' LIMIT 1

123 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741732 AND published='1' LIMIT 1

124 (442.9817199707): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294741732 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294741732 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 899075.98495483): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (!!!!! 1138604.1641235): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (169.99244689941): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

128 (81.062316894531): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

129 (140.90538024902): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

130 (86.069107055664): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

131 (84.877014160156): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

132 (75.101852416992): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

133 (464.91622924805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741732 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

134 (492.09594726562): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741732 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

135 (52.928924560547): SELECT name FROM jos_deeppockets WHERE id=213

136 (30.040740966797): SELECT name FROM jos_deeppockets WHERE id=213

137 (579.1187286377): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))213((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

138 (521.89826965332): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))213((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

139 (!!!!! 1477.9567718506): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741732 AND published='1' LIMIT 1

140 (995.87440490723): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741732 AND published='1' LIMIT 1

141 (!!!!! 7595.0622558594): TRUNCATE TABLE jos_trademed_module

142 (596.04644775391): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294741732 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

143 (530.95817565918): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294741732 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

144 (363.82675170898): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741732 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

145 (63.896179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741732 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

146 (83.92333984375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741732 AND published='1' LIMIT 1

147 (70.810317993164): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741732 AND published='1' LIMIT 1

148 (!!!!! 1510.8585357666): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

149 (124.21607971191): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741732 AND published='1' LIMIT 1

150 (87.976455688477): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741732 AND published='1' LIMIT 1

151 (!!!!! 2842.1878814697): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294741732 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294741732 AND type='deeppockets_item' AND published='1' LIMIT 1

152 (137.0906829834): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=213 or channel_id is null)

153 (40.054321289062): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=213 or channel_id is null)

154 (65.803527832031): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

155 (!!!!! 3796.1006164551): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741732 AND published='1' LIMIT 1

156 (109.19570922852): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741732 AND published='1' LIMIT 1

157 (76.055526733398): select jos_twitters.link from jos_twitters where cat=10

158 (44.107437133789): select jos_facebook.link from jos_facebook where cat=10

159 (41.961669921875): select jos_google_plus.link from jos_google_plus where cat=10

160 (42.915344238281): select jos_linkedin.link from jos_linkedin where cat=10

161 (368.83354187012): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

162 (!!!!! 1379.0130615234): insert into jos_banners_delta values (14615,'2025-06-20 19:24:15','216.73.216.120','view'),(14202,'2025-06-20 19:24:15','216.73.216.120','view'),(14203,'2025-06-20 19:24:15','216.73.216.120','view')

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