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Brain atrophy rates predict subsequent clinical conversion in normal elderly and amnestic MCI
C R Jack1, M M Shiung, S D Weigand
1Department of Diagnostic Radiology, Mayo Clinic and Foundation, Rochester, MN 55905, USA. jack.clifford@mayo.edu
Objective:
To test the hypothesis that the atrophy rate measured from serial MRI studies is associated with time to subsequent clinical conversion to a more impaired state in both cognitively healthy elderly subjects and in subjects with amnestic mild cognitive impairment (MCI).
Methods:
Ninety-one healthy elderly patients and 72 patients with amnestic MCI who met inclusion criteria were identified from the Mayo Alzheimer's Disease Research Center and Alzheimer's Disease Patient Registry. Atrophy rates of four different brain structures--hippocampus, entorhinal cortex, whole brain, and ventricle--were measured from a pair of MRI studies separated by 1 to 2 years. The time of the second scan marked the beginning of the clinical observation period.
Results:
During follow-up, 13 healthy patients converted to MCI or Alzheimer disease (AD), whereas 39 MCI subjects converted to AD. Among those healthy at baseline, only larger ventricular annual percent volume change (APC) was associated with a higher risk of conversion (hazard ratio for a 1-SD increase 1.9, p = 0.03). Among MCI subjects, both greater ventricular volume APC (hazard ratio for a 1-SD increase 1.7, p < 0.001) and greater whole brain APC (hazard ratio for a 1-SD increase 1.4, p = 0.007) increased the risk of conversion to AD. Both ventricular APC (hazard ratio for a 1-SD increase 1.59, p = 0.001) and whole brain APC (hazard ratio for a 1-SD increase 1.32, p = 0.009) provided additional predictive information to covariate-adjusted cross-sectional hippocampal volume at baseline about the risk of converting from MCI to AD.
Discussion:
Higher whole brain and ventricle atrophy rates 1 to 2 years before baseline are associated with an increased hazard of conversion to a more impaired state. Combining a measure of hippocampal volume at baseline with a measure of either whole brain or ventricle atrophy rates from serial MRI scans provides complimentary predictive information about the hazard of subsequent conversion from mild cognitive impairment to Alzheimer disease. However, overlap among those who did vs those who did not convert indicate that these measures are unlikely to provide absolute prognostic information for individual patients.
Insights
Brain atrophy rates, particularly in the ventricles and whole brain, predict clinical decline in healthy elderly and mild cognitive impairment (MCI) patients. Serial MRI scans offer valuable prognostic information for Alzheimer's disease progression.
Area of Science:
- Neurology
- Radiology
- Geriatrics
Background:
- Mild cognitive impairment (MCI) is a transitional stage between normal aging and Alzheimer's disease (AD).
- Early detection and prediction of conversion to AD are crucial for timely intervention.
- Serial magnetic resonance imaging (MRI) can detect brain structural changes over time.
Purpose of the Study:
- To assess if atrophy rates from serial MRI predict clinical progression in cognitively healthy elderly and amnestic MCI subjects.
- To determine the association between brain structure atrophy rates and time to clinical conversion.
Main Methods:
- Ninety-one healthy elderly and 72 amnestic MCI subjects were analyzed.
- Atrophy rates of hippocampus, entorhinal cortex, whole brain, and ventricles were measured from MRI scans taken 1-2 years apart.
- Clinical conversion was monitored from the time of the second MRI scan.
Main Results:
- In healthy subjects, increased ventricular atrophy predicted conversion.
- In MCI subjects, increased ventricular and whole brain atrophy predicted conversion to AD.
- Both ventricular and whole brain atrophy rates provided predictive information beyond baseline hippocampal volume for MCI to AD conversion.
Conclusions:
- Accelerated whole brain and ventricular atrophy rates predict increased risk of clinical decline.
- Combining baseline hippocampal volume with serial MRI atrophy rates enhances prediction of MCI to AD conversion.
- These MRI-based measures offer valuable prognostic insights but may not provide absolute individual patient predictions.
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