Accelerated Brain Atrophy on Serial Computed Tomography: Potential Marker of the Progression of Alzheimer Disease
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Abdullah Bin Zahid1, Artem Mikheev, Neha Srivatsa
1From the *Department of Neurosurgery, New York University Langone Medical Center; †Department of Surgery, VA Harbor Healthcare System, Manhattan Campus; ‡Department of Radiology, Center for Biomedical Imaging, NYU Langone Medical Center; §New York University, Washington Square South; and ∥Steven and Alexandra Cohen Veterans Center for Post-Traumatic Stress and Traumatic Brain Injury, New York, NY.
Objective:
The aim of this study was to validate computed tomography (CT)-based longitudinal markers of the progression of Alzheimer disease (AD).
Materials And Methods:
We retrospectively studied 33 AD patients and 39 nondemented patients with other neurological illnesses (non-AD) having 4 to 12 CT examinations of the head, with over a mean (SD) of 3.9 (1.7) years. At each time point, we applied an automatic software to measure whole brain, cerebrospinal fluid, and intracranial space volumes. Longitudinal measures were then related to disease status and time since the first scan using hierarchical models.
Results:
Absolute brain volume loss accelerated for non-AD patients by 0.86 mL/y (95% confidence interval [CI], 0.64-1.08 mL/y) and 1.5× faster, that is, 1.32 mL/y (95% CI, 1.09-1.56 mL/y) for AD patients (P = 0.006). In terms of brain volume normalized to intracranial space, the acceleration in atrophy rate for non-AD patients was 0.0578%/y (95% CI, 0.0389%/y to 0.0767%/y), again 1.5× faster, that is, 0.0919%/y (95% CI, 0.0716%/y to 0.1122%/y) for AD patients (P = 0.017). This translates to an increase in atrophy rate from 0.5% to 1.4% in AD versus to 1.1% in non-AD group after 10 years.
Conclusions:
Brain volumetry on CT reliably detected accelerated volume loss in AD and significantly lower acceleration factor in age-matched non-AD patients, leading to the possibility of its use to monitor the progression of cognitive decline and dementia.
