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CSF dynamics as a predictor of cognitive progression.

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|February 25, 2021
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Summary

Disproportionately enlarged subarachnoid-space hydrocephalus (DESH) is linked to faster cognitive decline, particularly in attention and global cognition. Identifying DESH features may aid in predicting cognitive impairment and selecting participants for clinical trials.

Keywords:
Cognitive impairmentDisproportionately enlarged subarachnoid-space hydrocephalusMRI

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Area of Science:

  • Neurology
  • Radiology
  • Gerontology

Background:

  • Disproportionately enlarged subarachnoid-space hydrocephalus (DESH) is an imaging marker associated with cerebrospinal fluid (CSF) dynamics disorders.
  • The clinical significance of DESH concerning cognitive decline in community settings remains underexplored.

Purpose of the Study:

  • To investigate the association between DESH and cognitive decline in a population-based cohort.
  • To determine if DESH imaging features predict the progression of cognitive impairment.

Main Methods:

  • Utilized a support vector machine method to calculate a "DESH score" from T1-weighted MRI scans in the Mayo Clinic Study of Aging (MCSA) cohort.
  • Employed Cox proportional hazards models to assess the hazard of progression to mild cognitive impairment or dementia.
  • Used linear mixed effects models to estimate annual changes in cognitive z scores across various domains (memory, attention, language, visuospatial) and a global score.

Main Results:

  • A higher DESH score was associated with an increased hazard of progression to cognitive impairment (HR 1.12, p=0.11).
  • Global and attention cognition showed significantly faster decline (0.015 and 0.016 z/year, respectively) with higher DESH scores (p<0.05).
  • DESH imaging features independently predicted cognitive decline, even after accounting for factors like age, cortical thickness, and APOE status.

Conclusions:

  • Imaging features indicative of disordered CSF dynamics (DESH) are an independent predictor of subsequent cognitive decline.
  • Identifying individuals with DESH may be clinically significant for predicting cognitive impairment and for participant selection in clinical trials.
  • DESH is present in the general population and contributes to cognitive decline, highlighting its potential clinical relevance.