Hippocampal subfield volumetry in mild cognitive impairment, Alzheimer's disease and semantic dementia

Background

Hippocampal atrophy is a well-known feature of Alzheimer's disease (AD), but sensitivity and specificity of hippocampal volumetry are limited. Neuropathological studies have shown that hippocampal subfields are differentially vulnerable to AD; hippocampal subfield volumetry may thus prove to be more accurate than global hippocampal volumetry to detect AD.

Methods

CA1, subiculum and other subfields were manually delineated from 40 healthy controls, 18 AD, 17 amnestic Mild Cognitive Impairment (aMCI), and 8 semantic dementia (SD) patients using a previously developed high resolution MRI procedure. Non-parametric group comparisons and receiver operating characteristic (ROC) analyses were conducted. Complementary analyses were conducted to evaluate differences of hemispheric asymmetry and anterior-predominance between AD and SD patients and to distinguish aMCI patients with or without β-amyloid deposition as assessed by Florbetapir-TEP.

Results

Global hippocampi were atrophied in all three patient groups and volume decreases were maximal in the CA1 subfield (22% loss in aMCI, 27% in both AD and SD; all p < 0.001). In aMCI, CA1 volumetry was more accurate than global hippocampal measurement to distinguish patients from controls (areas under the ROC curve = 0.88 and 0.76, respectively; p = 0.05) and preliminary analyses suggest that it was independent from the presence of β-amyloid deposition. In patients with SD, whereas the degree of CA1 and subiculum atrophy was similar to that found in AD patients, hemispheric and anterior–posterior asymmetry were significantly more marked than in AD with greater involvement of the left and anterior hippocampal subfields.

Conclusions

The findings suggest that CA1 measurement is more sensitive than global hippocampal volumetry to detect structural changes at the pre-dementia stage, although the predominance of CA1 atrophy does not appear to be specific to AD pathophysiological processes.

•

Using 3 T MRI, hippocampal subfields were measured in aMCI, AD and SD and controls.

•

CA1 atrophy was found to be predominant in all patient groups.

•

CA1 volume was the best discriminating measure between controls and aMCI patients.

•

AD and SD differed in asymmetry and anterior-predominance, not in subfield atrophy.

Relationships between years of education and gray matter volume, metabolism and functional connectivity in healthy elders

More educated elders are less susceptible to age-related or pathological cognitive changes. We aimed at providing a comprehensive contribution to the neural mechanism underlying this effect thanks to a multimodal approach. Thirty-six healthy elders were selected based on neuropsychological assessments and cerebral amyloid imaging, i.e. as presenting normal cognition and a negative florbetapir-PET scan. All subjects underwent structural MRI, FDG-PET and resting-state functional MRI scans. We assessed the relationships between years of education and i) gray matter volume, ii) gray matter metabolism and iii) functional connectivity in the brain areas showing associations with both volume and metabolism. Higher years of education were related to greater volume in the superior temporal gyrus, insula and anterior cingulate cortex and to greater metabolism in the anterior cingulate cortex. The latter thus showed both volume and metabolism increases with education. Seed connectivity analyses based on this region showed that education was positively related to the functional connectivity between the anterior cingulate cortex and the hippocampus as well as the inferior frontal lobe, posterior cingulate cortex and angular gyrus. Increased connectivity was in turn related with improved cognitive performances. Reinforcement of the connectivity of the anterior cingulate cortex with distant cortical areas of the frontal, temporal and parietal lobes appears as one of the mechanisms underlying education-related reserve in healthy elders.

Metabolic and structural connectivity within the default mode network relates to working memory performance in young healthy adults

Studies of functional connectivity suggest that the default mode network (DMN) might be relevant for cognitive functions. Here, we examined metabolic and structural connectivity between major DMN nodes, the posterior cingulate (PCC) and medial prefrontal cortex (MPFC), in relation to normal working memory (WM). DMN was captured using independent component analysis of [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) data from 35 young healthy adults (27.1 ± 5.1 years). Metabolic connectivity, a correlation between FDG uptake in PCC and MPFC, was examined in groups of subjects with (relative to median) low (n=18) and high (n=17) performance on digit span backward test as an index of verbal WM. In addition, fiber tractography based on PCC and MPFC nodes as way points was performed in a subset of subjects. FDG uptake in the DMN nodes did not differ between high and low performers. However, significantly (p=0.01) lower metabolic connectivity was found in the group of low performers. Furthermore, as compared to high performers, low performers showed lower density of the left superior cingulate bundle. Verbal WM performance is related to metabolic and structural connectivity within the DMN in young healthy adults. Metabolic connectivity as quantified with FDG-PET might be a sensitive marker of the normal variability in some cognitive functions.

Amyloid imaging in cognitively normal individuals, at-risk populations and preclinical Alzheimer's disease

Recent developments of PET amyloid ligands have made it possible to visualize the presence of Aβ deposition in the brain of living participants and to assess the consequences especially in individuals with no objective sign of cognitive deficits. The present review will focus on amyloid imaging in cognitively normal elderly, asymptomatic at-risk populations, and individuals with subjective cognitive decline. It will cover the prevalence of amyloid-positive cases amongst cognitively normal elderly, the influence of risk factors for AD, the relationships to cognition, atrophy and prognosis, longitudinal amyloid imaging and ethical aspects related to amyloid imaging in cognitively normal individuals. Almost ten years of research have led to a few consensual and relatively consistent findings: some cognitively normal elderly have Aβ deposition in their brain, the prevalence of amyloid-positive cases increases in at-risk populations, the prognosis for these individuals is worse than for those with no Aβ deposition, and significant increase in Aβ deposition over time is detectable in cognitively normal elderly. More inconsistent findings are still under debate; these include the relationship between Aβ deposition and cognition and brain volume, the sequence and cause-to-effect relations between the different AD biomarkers, and the individual outcome associated with an amyloid positive versus negative scan. Preclinical amyloid imaging also raises important ethical issues. While amyloid imaging is definitely useful to understand the role of Aβ in early stages, to define at-risk populations for research or for clinical trial, and to assess the effects of anti-amyloid treatments, we are not ready yet to translate research results into clinical practice and policy. More researches are needed to determine which information to disclose from an individual amyloid imaging scan, the way of disclosing such information and the impact on individuals and on society.

Subjective cognition and amyloid deposition imaging: a Pittsburgh Compound B positron emission tomography study in normal elderly individuals

OBJECTIVE

To study the relationship between subjective cognition and the neuropathological hallmark of Alzheimer disease (AD), amyloid-β (Aβ) deposition, using carbon 11-labeled Pittsburgh Compound B (PiB) positron emission tomography in normal elderly individuals.

DESIGN

Cross-sectional analysis.

SUBJECTS

Forty-eight cognitively normal elderly subjects (11 with high PiB uptake and 28 with low PiB uptake) were included. All underwent clinical and neuropsychological evaluations, magnetic resonance imaging, and positron emission tomography.

SETTING

Berkeley Aging Cohort Study.

MAIN OUTCOME MEASURE

Relationship between PiB uptake and subjective cognition measures.

RESULTS

Subjects with high PiB uptake showed significantly lower performance than those with low PiB uptake on an episodic memory measure and were less confident about their general memory abilities when required to evaluate themselves relative to other people of the same age. High and low PiB uptake groups did not differ on the accuracy of their cognitive self-reports compared with objective cognitive performance. General memory self-reports from the whole group were significantly correlated with regional PiB uptake in the right medial prefrontal cortex and anterior cingulate cortex and in the right precuneus and posterior cingulate cortex. Reduced confidence about memory abilities was associated with greater PiB uptake in these brain regions. All results were independent of demographic variables and depressive affects.

CONCLUSIONS

A decrease of self-confidence about memory abilities in cognitively normal elderly subjects may be related to the neuropathological hallmark of AD measured with PiB-positron emission tomography. Subjective cognitive impairment may represent a very early clinical manifestation of AD.

Metamemory monitoring in mild cognitive impairment: Evidence of a less accurate episodic feeling-of-knowing

This study aimed at exploring metamemory and specifically the accuracy of memory monitoring in mild cognitive impairment (MCI) using an episodic memory feeling-of-knowing (FOK) procedure. To this end, 20 people with MCI and 20 matched control participants were compared on the episodic FOK task. Results showed that the MCI group made less accurate FOK predictions than the control group by overestimating their memory performance on a recognition task. The MCI overestimation behavior was found to be critically related to the severity of their cognitive decline. In the light of recent neuroanatomical models showing the involvement of a temporal-frontal network underlying accurate FOK predictions, the role of memory and executive processes was evaluated. Thus, participants were also administered memory and executive neuropsychological tests. Correlation analysis revealed a between-group differential pattern indicating that FOK accuracy was primarily related to memory abilities in people with MCI, whereas it was specifically related to executive functioning in control participants. The lesser ability of people with MCI to assess their memory status accurately on an episodic FOK task is discussed in relation to both their subjective memory complaints and to their actual memory deficits which might be mediated by the brain vulnerability of their hippocampus and medial temporal system. It is suggested that their memory weakness may lead people with MCI to use other less reliable forms of memory monitoring.

Episodic feeling-of-knowing accuracy and cued recall in the elderly: evidence for double dissociation involving executive functioning and processing speed

This research investigated adult age differences in a metamemory monitoring task-episodic feeling-of-knowing (FOK) and in an episodic memory task-cued recall. Executive functioning and processing speed were examined as mediators of these age differences. Young and elderly adults were administered an episodic FOK task, a cued recall task, executive tests and speed tests. Age-related decline was observed on all the measures. Correlation analyses revealed a pattern of double dissociation which indicates a specific relationship between executive score and FOK accuracy, and between speed score and cued recall. When executive functioning and processing speed were evaluated concurrently on FOK and cued recall variables, hierarchical regression analyses showed that executive score was a better mediator of age-related variance in FOK, and that speed score was the better mediator of age-related variance in cued recall.