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Published on: April 14, 2014
MRI biomarkers of vascular damage and atrophy predicting mortality in a memory clinic population
Wouter J P Henneman1, Jasper D Sluimer, Charlotte Cordonnier
1Department of Radiology and Alzheimer Center, VU University Medical Center, Amsterdam, The Netherlands. w.henneman@vumc.nl
Background And Purpose:
MRI biomarkers play an important role in the diagnostic work-up of dementia, but their prognostic value is less well-understood. We investigated if simple MRI rating scales predict mortality in a memory clinic population.
Methods:
We included 1138 consecutive patients attending our memory clinic. Diagnostic categories were: subjective complaints (n=220), mild cognitive impairment (n=160), Alzheimer disease (n=357), vascular dementia (n=46), other dementia (n=136), and other diagnosis (n=219). Baseline MRIs were assessed using visual rating scales for medial temporal lobe atrophy (range, 0-4), global cortical atrophy (range, 0-3), and white matter hyperintensities (range, 0-3). Number of microbleeds and presence of infarcts were recorded. Cox-regression models were used to calculate the risk of mortality.
Results:
Mean follow-up duration was 2.6 (+/-1.9) years. In unadjusted models, all MRI markers except infarcts predicted mortality. After adjustment for age, sex, and diagnosis, white matter hyperintensities, and microbleeds predicted mortality (white matter hyperintensities: hazard ratio [HR], 1.2; 95% CI, 1.0-1.4; microbleeds: HR, 1.02 95% CI, 1.00-1.03; categorized: HR, 1.5; 95% CI, 1.1-2.0). The predictive effect of global cortical atrophy was restricted to younger subjects (HR, 1.7; 95% CI, 1.2-2.6). An interaction between microbleeds and global cortical atrophy indicated that mortality was especially high in patients with both microbleeds and global cortical atrophy.
Conclusions:
Simple MRI biomarkers, in addition to their diagnostic use, have a prognostic value with respect to mortality in a memory clinic population. Microbleeds were the strongest predictor of mortality.
Insights
Simple MRI scans can predict mortality risk in memory clinic patients. Microbleeds and white matter changes are key indicators, offering prognostic value beyond diagnosis.
Area of Science:
- Neurology
- Radiology
- Geriatrics
Background:
- Magnetic Resonance Imaging (MRI) biomarkers are crucial for diagnosing dementia.
- The prognostic implications of these MRI findings, particularly for mortality risk, are less understood.
- Memory clinic populations represent a diverse group with various cognitive complaints and diagnoses.
Purpose of the Study:
- To evaluate the prognostic value of simple Magnetic Resonance Imaging (MRI) rating scales in predicting mortality.
- To determine if visual assessment of brain atrophy and white matter changes can identify patients at higher risk of death.
- To investigate specific MRI markers associated with increased mortality in a memory clinic setting.
Main Methods:
- A cohort of 1138 memory clinic patients with diagnoses including subjective complaints, mild cognitive impairment, Alzheimer's disease, and vascular dementia were included.
- Baseline MRI scans were assessed using visual rating scales for medial temporal lobe atrophy, global cortical atrophy, and white matter hyperintensities.
- Cox-regression models were employed to analyze the association between MRI markers and mortality risk, adjusting for demographic and diagnostic factors.
Main Results:
- In a mean follow-up of 2.6 years, white matter hyperintensities and microbleeds significantly predicted mortality after adjusting for confounders.
- White matter hyperintensities (HR, 1.2) and microbleeds (HR, 1.02) were independently associated with increased mortality risk.
- Global cortical atrophy predicted mortality primarily in younger individuals, and an interaction between microbleeds and global cortical atrophy indicated particularly high mortality risk.
Conclusions:
- Simple MRI biomarkers possess significant prognostic value for mortality in memory clinic patients, extending beyond their diagnostic utility.
- Microbleeds emerged as the strongest independent predictor of mortality in this cohort.
- These findings highlight the potential of routine MRI assessments to identify individuals at elevated risk of death, aiding in clinical management.
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