Increased plasma glucose (PG) levels can alter the cerebral distribution pattern of 18 F-FDG uptake and reduce 18 F-FDG uptake, especially in the precuneus. The 18 F-FDG distribution pattern in cognitively normal subjects is described as an Alzheimer disease (AD)-like pattern. The aim of this study was to determine the fasting PG levels that can reduce 18 F-FDG uptake in the precuneus. Methods: Fifty-one cognitively normal volunteers (mean age ± SD, 69.7 ± 5.9 y) underwent 18 F-FDG PET scanning and were divided into 2 groups according to the level of fasting PG at the time of PET scanning: control (n 5 31, 80 mg/dL # fasting PG , 100 mg/dL) and impaired fasting glucose (IFG) (n 5 20, 100 mg/dL # fasting PG , 110 mg/dL). 18 F-FDG uptake was compared between the 2 groups using voxelwise analyses with a global normalization method and volume-of-interest (VOI)-based analyses. VOIs were placed on the precuneus, posterior cingulate, and visual cortex, and the ratio of the uptake value on the precuneus VOI to that on the visual cortex VOI (PreCne/VC ratios) and to that on the posterior cingulate VOI (PreCne/PostCin ratios) was calculated. Results: Whole-brain voxelwise analyses showed that 18 F-FDG uptake in the precuneus was significantly lower in the IFG group (P , 0.05, familywise error rate-corrected) than in the control group. VOI analyses showed significantly lower PreCne/VC ratios (P 5 0.002) and PreCne/PostCin ratios (P 5 0.004) in the IFG group than in the control group. Conclusion: The present study confirmed that increased fasting PG levels decrease 18 F-FDG uptake, especially in the precuneus, as in the AD-like pattern. Furthermore, the study provided initial evidence that the AD-like pattern can appear even in an individual with a mildly higher level of fasting PG (100-110 mg/dL). As a PET radiotracer to estimate cerebral metabolic rates of glucose utilization, 18 F-FDG provides information on neuronal density and function. Glucose hypometabolism is associated with reduced uptake of 18 F-FDG (1), reflecting a loss of neuronal cell number or activity. Patients with Alzheimer disease (AD) demonstrate prominently reduced uptake of 18 F-FDG in the precuneus and posterior cingulate regions (2). This characteristic distribution pattern of 18 F-FDG uptake is described as an AD pattern and is useful for the early diagnosis of AD.Interestingly, in cognitively normal subjects with an increased level of plasma glucose (PG), reduced uptake of 18 F-FDG can be observed, especially in the precuneus, and its distribution pattern is described as an AD-like pattern (3,4). In addition, a recent study showed that the AD-like pattern during a hyperglycemic state is reversible and independent of amyloid-b (Ab) deposition or apolipoprotein E e4 genotype (5). These studies indicate that an individual with higher PG levels can be erroneously diagnosed with AD using 18 F-FDG and PET due to reduced uptake of 18 F-FDG in the precuneus.Guidelines for 18 F-FDG PET brain imaging usually recommend rescheduling the scanning if the PG leve...