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Using Retinal Imaging to Study Dementia
Published on: November 6, 2017
Change in multimodal MRI markers predicts dementia risk in cerebral small vessel disease
Eva A Zeestraten1, Andrew J Lawrence2, Christian Lambert2
1From the Neuroscience Research Centre (E.A.Z., C.L., P.B., T.R.B.), Cardiovascular and Cell Sciences Research Institute, St George's University of London; Stroke Research Group (A.J.L., R.L.B., H.S.M.), Clinical Neurosciences, University of Cambridge; Atkinson Morley Regional Neuroscience Centre (A.D.M.), St George's NHS Healthcare Trust; and Department of Psychology (R.G.M.), King's College Institute of Psychiatry, Psychology, and Neuroscience, London, UK. p1207006@sgul.ac.uk.
Objective:
To determine whether MRI markers, including diffusion tensor imaging (DTI), can predict cognitive decline and dementia in patients with cerebral small vessel disease (SVD).
Methods:
In the prospective St George's Cognition and Neuroimaging in Stroke study, multimodal MRI was performed annually for 3 years and cognitive assessments annually for 5 years in a cohort of 99 patients with SVD, defined as symptomatic lacunar stroke and confluent white matter hyperintensities (WMH). Progression to dementia was determined in all patients. Progression of WMH, brain volume, lacunes, cerebral microbleeds, and a DTI measure (the normalized peak height of the mean diffusivity histogram distribution) as a marker of white matter microstructural damage were determined.
Results:
Over 5 years of follow-up, 18 patients (18.2%) progressed to dementia. A significant change in all MRI markers, representing deterioration, was observed. The presence of new lacunes, and rate of increase in white matter microstructural damage on DTI, correlated with both decline in executive function and global functioning. Growth of WMH and deterioration of white matter microstructure on DTI predicted progression to dementia. A model including change in MRI variables together with their baseline values correctly classified progression to dementia with a C statistic of 0.85.
Conclusions:
This longitudinal prospective study provides evidence that change in MRI measures including DTI, over time durations during which cognitive change is not detectable, predicts cognitive decline and progression to dementia. It supports the use of MRI measures, including DTI, as useful surrogate biomarkers to monitor disease and assess therapeutic interventions.
Insights
Magnetic resonance imaging (MRI) markers, including diffusion tensor imaging (DTI), can predict cognitive decline and dementia in cerebral small vessel disease (SVD) patients. These imaging biomarkers show potential for monitoring disease progression and evaluating treatments.
Area of Science:
- Neurology
- Radiology
- Neuroimaging
Background:
- Cerebral small vessel disease (SVD) is a common cause of cognitive decline and dementia.
- Early detection and prediction of cognitive decline in SVD are crucial for timely intervention.
Purpose of the Study:
- To investigate the predictive value of magnetic resonance imaging (MRI) markers, including diffusion tensor imaging (DTI), for cognitive decline and dementia in SVD patients.
- To assess the utility of MRI measures as surrogate biomarkers for disease monitoring and therapeutic assessment.
Main Methods:
- Prospective cohort study (St George's Cognition and Neuroimaging in Stroke) of 99 SVD patients.
- Annual multimodal MRI and cognitive assessments over 3 and 5 years, respectively.
- Evaluation of white matter hyperintensities (WMH), brain volume, lacunes, microbleeds, and DTI-derived white matter microstructural damage.
Main Results:
- 18.2% of patients progressed to dementia over 5 years.
- Deterioration in MRI markers, including DTI, was significant.
- New lacunes and increased white matter microstructural damage on DTI correlated with executive function decline and predicted dementia progression.
- A predictive model incorporating MRI changes achieved a C statistic of 0.85 for dementia progression.
Conclusions:
- Changes in MRI measures, including DTI, predict cognitive decline and dementia progression in SVD, even before cognitive changes are detectable.
- MRI measures, particularly DTI, serve as valuable surrogate biomarkers for monitoring SVD and assessing treatment efficacy.
