Aging in the CNS: comparison of gray/white matter volume and diffusion tensor data

Cerebral cortex structure in prodromal Huntington disease

Neuroimaging studies of subjects who are gene-expanded for Huntington Disease, but not yet diagnosed (termed prodromal HD), report that the cortex is "spared," despite the decrement in striatal and cerebral white-matter volume. Measurement of whole-cortex volume can mask more subtle, but potentially clinically relevant regional changes in volume, thinning, or surface area. The current study addressed this limitation by evaluating cortical morphology of 523 prodromal HD subjects. Participants included 693 individuals enrolled in the PREDICT-HD protocol. Of these participants, 523 carried the HD gene mutation (prodromal HD group); the remaining 170 were non gene-expanded and served as the comparison group. Based on age and CAG repeat length, gene-expanded subjects were categorized as "Far from onset," "Midway to onset," "Near onset," and "already diagnosed." MRI scans were processed using FreeSurfer. Cortical volume, thickness, and surface area were not significantly different between the Far from onset group and controls. However, beginning in the Midway to onset group, the cortex showed significant volume decrement, affecting most the posterior and superior cerebral regions. This pattern progressed when evaluating the groups further into the disease process. Areas that remained mostly unaffected included ventral and medial regions of the frontal and temporal cortex. Morphologic changes were mostly in thinning as surface area did not substantially change in most regions. Early in the course of HD, the cortex shows changes that are manifest as cortical thinning and are most robust in the posterior and superior regions of the cerebrum.

Correlation between degree of white matter hyperintensities and global gray matter volume decline rate

INTRODUCTION

Whether the degree of white matter hyperintensities (WMHs) shows a significant correlation with the rate of global gray matter volume decline over a period following initial baseline measurement remains unclear. The purpose of the present study was to reveal the relationship between the degree of WMHs at baseline and the rate of global gray matter volume decline by applying a longitudinal design.

METHODS

Using a 6-year longitudinal design and magnetic resonance images of the brains of 160 healthy individuals aged over 50 years and living in the community, we analyzed the correlation between degree of WMHs using Fazekas scaling at baseline and rate of global gray matter volume decline 6 years later. To obtain the rate of global gray matter volume decline, we calculated global gray matter volume and intracranial volume at baseline and at follow-up using a fully automated method.

RESULTS

The annual percentage change in the gray matter ratio (GMR, APC(GMR)), in which GMR represents the percentage of gray matter volume in the intracranial volume, showed a significant positive correlation with the degree of deep WMHs and periventricular WMHs at baseline, after adjusting for age, gender, present history of hypertension, and diabetes mellitus.

CONCLUSION

Our results suggest that degree of WMHs at baseline predicts the rate of gray matter volume decline 6 years later and that simple visual scaling of WMHs could contribute to predicting the rate of global gray matter volume decline.

Sex dimorphism in gray/white matter volume and diffusion tensor during normal aging

The purpose of this study is to elucidate sex differences in global and regional gray/white matter volume, mean diffusivity (MD), and fractional anisotropy (FA) during normal aging using voxel-based analysis. We studied 245 healthy right-handed subjects with a wide range of ages (115 women, 22-70 years; 130 men, 21-71 years). Regarding global effects, inclusion of a quadratic age term improved the fit to data for white matter fraction and MD, but not for global gray matter volume/fraction or FA. Regarding regional effects, we found anterior-dominant volume loss, FA decrease predominantly in the anterior white matter, and MD increase predominantly in perisylvian regions and periventricular white matter against age for both sexes. Compared with women, we found a steeper FA decline for men in the right inferior fronto-temporal areas, extending to the anterior cingulate cortex, and an accelerated MD increase for men in the bilateral frontal, temporal, and parietal areas. There was no area in which interaction of sex with age was significant for regional volume, or in which a steeper FA decline or accelerated MD increase for women was significant. Our results provide strong evidence of sex dimorphism in global and focal diffusion characteristics during normal aging.

Microstructural diffusion changes are independent of macrostructural volume loss in moderate to severe Alzheimer's disease

Although it is established that Alzheimer's disease (AD) leads to cerebral macrostructural atrophy, microstructural diffusion changes have also been observed, but it is not yet known whether these changes offer unique information about the disease pathology. Thus, a multi-modal imaging study was conducted to determine the independent contribution of each modality in moderate to severe AD. Seventeen patients with moderate-severe AD and 13 healthy volunteers underwent diffusion-weighted and T1-weighted MR scanning. Images were processed to obtain measures of macrostructural atrophy (gray and white matter volumes) and microstructural damage (fractional anisotropy and mean diffusivity). Microstructural diffusion changes independent of macrostructural loss were investigated using an ANCOVA where macrostructural maps were used as voxel-wise covariates. The reverse ANCOVA model was also assessed, where macrostructural loss was the dependent variable and microstructural diffusion tensor imaging maps were the imaging covariates. Diffusion differences between patients and controls were observed after controlling for volumetric differences in medial temporal, retrosplenial regions, anterior commissure, corona radiata, internal capsule, thalamus, corticopontine tracts, cerebral peduncle, striatum, and precentral gyrus. Independent volumetric differences were observed in the entorhinal cortex, inferior temporal lobe, posterior cingulate cortex, splenium and cerebellum. While it is well known that AD is associated with pronounced volumetric change, this study suggests that measures of microstructure provide unique information not obtainable with volumetric mapping in regions known to be pivotal in AD and in those thought to be spared. As such this work provides great understanding of the topography of pathological changes in AD that can be captured with imaging.

Ischemic stroke in the elderly: an overview of evidence

Stroke mostly occurs in elderly people and patient outcomes after stroke are highly influenced by age. A better understanding of the causes of stroke in the elderly might have important practical implications not only for clinical management, but also for preventive strategies and future health-care policies. In this Review, we explore the evidence from both human and animal studies relating to the effect of old age-in terms of susceptibility, patient outcomes and response to treatment-on ischemic stroke. Several aging-related changes in the brain have been identified that are associated with an increase in vulnerability to ischemic stroke in the elderly. Furthermore, risk factor profiles for stroke and mechanisms of ischemic injury differ between young and elderly patients. Elderly patients with ischemic stroke often receive less-effective treatment and have poorer outcomes than younger individuals who develop this condition. Neuroprotective agents for ischemic stroke have been sought for decades but none has proved effective in humans. One contributing factor for this translational failure is that most preclinical studies have used young animals. Future research on ischemic stroke should consider age as a factor that influences stroke prevention and treatment, and should focus on the management of acute stroke in the elderly to reduce the incidence and improve outcomes in this vulnerable group.

Changes in kinetics of amino acid uptake at the ageing ovine blood-cerebrospinal fluid barrier

Amino acids (AA) in brain are precisely controlled by blood-brain barriers, which undergo a host of changes in both morphology and function during ageing. The effect of these age-related changes on AA homeostasis in brain is not well described. This study investigated the kinetics of four AA (Leu, Phe, Ala and Lys) uptakes at young and old ovine choroid plexus (CP), the blood-cerebrospinal fluid (CSF) barrier (BCB), and measured AA concentrations in CSF and plasma samples. In old sheep, the weight of lateral CP increased, so did the ratio of CP/brain. The expansion of the CP is consistent with clinical observation of thicker leptomeninges in old age. AA concentrations in old CSF, plasma and their ratio were different from the young. Both V(max) and K(m) of Phe and Lys were significant higher compared to the young, indicating higher trans-stimulation in old BCB. Cross-competition and kinetic inhibition studies found the sensitivity and specificity of these transporters were impaired in old BCB. These changes may be the first signs of a compromised barrier system in ageing brain leading increased AA influx into the brain causing neurotoxicity.

Gray and white matter volumetric and diffusion tensor imaging (DTI) analyses in the early stage of first-episode schizophrenia

PURPOSE

To determine whether statistical analyses of quantitative MR imaging data, including morphological changes, mean diffusivity (MD), and fractional anisotropy (FA), could provide useful biomarkers in early stage of first-episode schizophrenia.

MATERIALS AND METHODS

Twenty-three patients, who met all the criteria in the DSM-IV-TR category for schizophrenia excluding the duration of the disease (less than 6 months of follow-up), were examined by MR imaging during the initial consultation. Nineteen of the 23 patients were finally diagnosed to have schizophrenia after a 6-month follow-up, and they were included in this study as having been in the early stage of first-episode schizophrenia. Nineteen healthy volunteers also underwent MR imaging as age-matched controls. Three-dimensional spoiled gradient recalled acquisition with steady state (3D-SPGR) and diffusion tensor imaging (DTI) were performed at 3T. Image processing for voxel-based morphometry, a fully automatic technique for a computational analysis of differences in regional brain volume throughout the entire brain, was conducted using the Statistical Parametric Mapping 5 software package (SPM5). The 3D-SPGR images in the native space were bias-corrected; spatially normalized; segmented into gray matter, white matter, and cerebrospinal fluid images; and intensity-modulated using SPM5. A voxel-based analysis was conducted using both the MD and FA maps computed from DTI. The customized MD and FA template specific to this study was created from all participants. Thereafter, all the MD and FA maps in the native space were transformed onto the stereotactic space by registering each of the images to the customized MD and FA template. The two groups were compared using SPM5. Age and sex were treated as confounding covariates.

RESULTS

The patients demonstrated a significant increase in the MD of the left parahippocampal gyrus, left insula, and right anterior cingulate gyrus in comparison to the control subjects (FDR corrected p<0.05). No significant difference was observed in the correlation between the gray/white matter volume and FA.

CONCLUSION

These findings suggest that structural abnormalities in the brain are present during the early stage of first-episode schizophrenia and MD might therefore be a sensitive marker for the detection of these abnormalities.

Fractional anisotropy of water diffusion in cerebral white matter across the lifespan

Determining the time of peak of cerebral maturation is vital for our understanding of when cerebral maturation ceases and the cerebral degeneration in healthy aging begins. We carefully mapped changes in fractional anisotropy (FA) of water diffusion for eleven major cerebral white matter tracts in a large group (831) of healthy human subjects aged 11-90. FA is a neuroimaging index of micro-structural white matter integrity, sensitive to age-related changes in cerebral myelin levels, measured using diffusion tensor imaging. The average FA values of cerebral white matter (WM) reached peak at the age 32 ± 6 years. FA measurements for all but one major cortical white matter tract (cortico-spinal) reached peaks between 23 and 39 years of age. The maturation rates, prior to age-of-peak were significantly correlated (r=0.74; p=0.01) with the rates of decline, past age-of-peak. Regional analysis of corpus callosum (CC) showed that thinly-myelinated, densely packed fibers in the genu, that connect pre-frontal areas, maturated later and showed higher decline in aging than the more thickly myelinated motor and sensory areas in the body and splenium of CC. Our findings can be summarized as: associative, cerebral WM tracts that reach their peak FA values later in life also show progressively higher age-related decline than earlier maturing motor and sensory tracts. These findings carry multiple and diverse implications for both theoretical studies of the neurobiology of maturation and aging and for the clinical studies of neuropsychiatric disorders.

Voxel-based analyses of gray/white matter volume and diffusion tensor data in major depression

The purpose of this study is to use voxel-based analysis to simultaneously elucidate regional changes in gray/white matter volume, mean diffusivity (MD), and fractional anisotropy (FA) in patients with unipolar major depressive disorder. We studied 21 right-handed patients and 42 age- and gender-matched right-handed normal subjects. Local areas showing significant gray matter volume reduction in depressive patients compared with controls were observed in the right parahippocampal gyrus, hippocampus, bilateral middle frontal gyri, bilateral anterior cingulate cortices, left parietal and occipital lobes, and right superior temporal gyrus. Local areas showing an increase of MD in depressive patients were observed in the bilateral parahippocampal gyri, hippocampus, pons, cerebellum, left frontal and temporal lobes, and right frontal lobe. There was no significant difference between the two groups for FA and white matter volume in the entire brain. Although there was no local area where brain volume and MD were significantly correlated with disease severity, FA tended to correlate negatively with total days depressed in the right anterior cingulate and the left frontal white matter. These results suggest that the frontolimbic neural circuit might play an important role in the neuropathology of patients with major depressive disorder.

The elderly as a sensitive population in environmental exposures: making the case

The US population is aging. CDC has estimated that 20% of all Americans will be 65 or older by the year 2030. As a part of the aging process, the body gradually deteriorates and physiologic and metabolic limitations arise. Changes that occur in organ anatomy and function present challenges for dealing with environmental stressors of all kinds, ranging from temperature regulation to drug metabolism and excretion. The elderly are not just older adults, but rather are individuals with unique challenges and different medical needs than younger adults. The ability of the body to respond to physiological challenge presented by environmental chemicals is dependent upon the health of the organ systems that eliminate those substances from the body. Any compromise in the function of those organ systems may result in a decrease in the body's ability to protect itself from the adverse effects of xenobiotics. To investigate this issue, we performed an organ system-by-organ system review of the effects of human aging and the implications for such aging on susceptibility to drugs and xenobiotics. Birnbaum (1991) reported almost 20 years ago that it was clear that the pharmacokinetic behavior of environmental chemicals is, in many cases, altered during aging. Yet, to date, there is a paucity of data regarding recorded effects of environmental chemicals on elderly individuals. As a result, we have to rely on what is known about the effects of aging and the existing data regarding the metabolism, excretion, and adverse effects of prescription medications in that population to determine whether the elderly might be at greater risk when exposed to environmental substances. With increasing life expectancy, more and more people will confront the problems associated with advancing years. Moreover, although proper diet and exercise may lessen the immediate severity of some aspects of aging, the process will continue to gradually degrade the ability to cope with a variety of injuries and diseases. Thus, the adverse effects of long-term, low-level exposure to environmental substances will have a longer time to be manifested in a physiologically weakened elderly population. When such exposures are coupled with concurrent exposure to prescription medications, the effects could be devastating. Public health officials must be knowledgeable about the sensitivity of the growing elderly population, and ensure that the use of health guidance values (HGVs) for environmental contaminants and other substances give consideration to this physiologically compromised segment of the population.

Age-related changes in regional brain volume evaluated by atlas-based method

INTRODUCTION

The effects of aging on brain volume are generally investigated using voxel-based morphometry (VBM) or the manually traced region-of-interest (ROI) method. We introduce an atlas-based method as a methodological alternative that calculates absolute volume as a non-biased and semi-automatic whole-brain technique.

METHODS

We enrolled 115 healthy females (mean age, 36.7 years) and 130 healthy males (mean age, 37.1 years). Volume data were acquired using a 1.5 tesla magnetic resonance scanner. After spatial normalization, a lobar-based atlas template was applied, and the absolute volumes of the frontal, temporal, parietal, and occipital lobes and the sublobar and limbic areas were calculated bilaterally. The effects of age on regional brain volume were evaluated statistically.

RESULTS

The volume of all ROIs declined linearly with increasing age. The bilateral frontal lobes showed the steepest involution. Analysis of variance revealed significant laterality and interaction of gender and age.

CONCLUSION

The atlas-based method introduced in the present study has advantages over the manually traced ROI method in its objectivity, coverage, and time requirement and has an advantage over the VBM method in its computability of absolute volume. The results are largely in agreement with those reported previously, thereby reconfirming the importance of matching gender and age in analyzing brain disorders.

Age-related microstructural changes in subcortical white matter during postadolescent periods in men revealed by diffusion-weighted MR imaging

Continuous maturation of cerebral white matter (WM) in the postadolescent period is not fully understood. To elucidate the time course and location of possible postadolescent maturational changes in cerebral WM, we studied 60 healthy male subjects who were in their second to seventh decade using diffusion-weighted imaging. Mean diffusivity (MD) in subcortical WM was measured in 78 cortical regions in each subject's brain using an automated method. Regression analysis was used to model the age-related change in MD by either a linear or a quadratic function in each region. Age-related changes in subcortical MD were best modeled by either a linear function or a quadratic function in 27 regions including language-related regions, visual or multimodal areas in the bilateral occipital and temporal lobes, limbic areas including the bilateral parahippocampal gyri, and the bilateral postcentral and left precentral gyri. In these regions, the MD rapidly decreased until middle age and thereafter reached a plateau. Our results revealed microstructural changes in local subcortical WM and suggests a continuing maturational process in postoadolescent periods.

Normal aging in the basal ganglia evaluated by eigenvalues of diffusion tensor imaging

BACKGROUND AND PURPOSE

The age effect on the diffusion pattern in the basal ganglia differs from that in the white matter. The main purpose of our study was to provide further insight into the change of water diffusion in the basal ganglia during human brain aging by using the eigenvalues of DTI.

MATERIALS AND METHODS

We examined 71 healthy subjects (mean age, 41.8 +/- 14.5 years; age range, 20-79 years). The values of MD, FA, and the eigenvalues lambda(1) and lambda(23) (lambda(23) = [lambda(2) + lambda(3)]/2) were determined in regions of the head of the caudate nucleus, putamen, globus pallidus, and in some regions of white matter. The age-dependence of these measurements was tested for statistical significance by using the Pearson correlation analysis.

RESULTS

A significant reduction of MD with aging was found in the head of caudate nucleus (r = -0.319, P = .007) and putamen (r = -0.410, P < .001), and an increase in FA with aging was found in the putamen (r = 0.535, P < .001). Eigenvalue lambda(23) showed a significant age-related decrease in the putamen (r = -0.451, P < .001) and the head of the caudate nucleus (r = -0.312, P = .008), but no significant changes of lambda(23) were found in the globus pallidus. The results for eigenvalue lambda(1) in the head of caudate nucleus (r = -0.299, P = .011) were close to statistical significance.

CONCLUSIONS

The eigenvalues provide more insights into the different diffusion patterns in the basal ganglia during human brain aging.

Neurophysiological changes with age probed by inverse modeling of EEG spectra

OBJECTIVE

To investigate age-associated changes in physiologically-based EEG spectral parameters in the healthy population.

METHODS

Eyes-closed EEG spectra of 1498 healthy subjects aged 6-86 years were fitted to a mean-field model of thalamocortical dynamics in a cross-sectional study. Parameters were synaptodendritic rates, cortical wave decay rates, connection strengths (gains), axonal delays for thalamocortical loops, and power normalizations. Age trends were approximated using smooth asymptotically linear functions with a single turning point. We also considered sex differences and relationships between model parameters and traditional quantitative EEG measures.

RESULTS

The cross-sectional data suggest that changes tend to be most rapid in childhood, generally leveling off at age 15-20 years. Most gains decrease in magnitude with age, as does power normalization. Axonal and dendritic delays decrease in childhood and then increase. Axonal delays and gains show small but significant sex differences.

CONCLUSIONS

Mean-field brain modeling allows interpretation of age-associated EEG trends in terms of physiological processes, including the growth and regression of white matter, influencing axonal delays, and the establishment and pruning of synaptic connections, influencing gains.

SIGNIFICANCE

This study demonstrates the feasibility of inverse modeling of EEG spectra as a noninvasive method for investigating large-scale corticothalamic dynamics, and provides a basis for future comparisons.

Microstructural white matter changes in normal aging: a diffusion tensor imaging study with higher-order polynomial regression models

Diffusion tensor imaging (DTI) has already proven to be a valuable tool when investigating both global and regional microstructural white matter (WM) brain changes in the human aging process. Although subject to many criticisms, voxel-based analysis is currently one of the most common and preferred approaches in such DTI aging studies. In this context, voxel-based DTI analyses have assumed a 'linear' correlation when finding the significant brain regions that relate age with a particular diffusion measure of interest. Recent literature, however, has clearly demonstrated 'non-linear' relationships between age and diffusion metrics by using region-of-interest and tractography-based approaches. In this work, we incorporated polynomial regression models in the voxel-based DTI analysis framework to assess age-related changes in WM diffusion properties (fractional anisotropy and axial, transverse, and mean diffusivity) in a large cohort of 346 subjects (25 to 81 years old). Our novel approach clearly demonstrates that voxel-based DTI analyses can greatly benefit from incorporating higher-order regression models when investigating potential relationships between aging and diffusion properties.

Aging effects on cerebral asymmetry: a voxel-based morphometry and diffusion tensor imaging study

The hemispheres of the human brain are functionally and structurally asymmetric. The purpose of this study was to evaluate the effects of aging on gray and white matter asymmetry. Two hundred twenty-six right-handed normal volunteers aged 21-71 years were included in this study. The effects of aging on gray matter volume asymmetry and white matter fractional anisotropy asymmetry were evaluated with use of voxel-based morphometry and voxel-based analysis of fractional anisotropy maps derived from diffusion tensor imaging (DTI), respectively. The voxel-based morphometry showed no significant correlation between age and gray matter volume asymmetry. The voxel-based analysis of DTI also showed no significant correlation between age and white matter fractional anisotropy asymmetry. Our results showed no significant effects of aging on either gray matter volume asymmetry or white matter fractional anisotropy asymmetry.

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Previous studies have reported continued focal gray matter loss after the clinical onset of schizophrenia. Longitudinal assessments in chronic illness, of white matter in particular, have been less conclusive.

We used diffusion-tensor and structural magnetic resonance imaging in 16 healthy subjects and 49 chronic schizophrenia patients, subdivided into good-outcome (n=23) and poor-outcome (n=26) groups, scanned twice 4 years apart. Fractional anisotropy, gray matter and white matter volumes were parcellated into the Brodmann’s areas and entered into multiway ANCOVAs.

At baseline, schizophrenia patients had 1) lower anisotropy in frontoparietal white matter, 2) larger posterior frontal white matter volumes, and 3) smaller frontal, temporal, and parietal gray matter volumes. On follow-up, healthy subjects showed a more pronounced 1) decline in anisotropy, 2) expansion of regional white matter volumes, and 3) reduction in regional gray matter volumes than schizophrenia patients. Good-outcome patients showed a more pronounced decline in white matter anisotropy and a less pronounced increase in white matter volumes than poor-outcome patients. Poor-outcome patients displayed a greater gray matter loss throughout the brain than good-outcome patients.

In the chronic phase of the illness, longitudinal changes in both gray and white matter are in the direction of an effacement of between-group differences among schizophrenia patients and healthy subjects. Similarly, preexisting white matter differences between good-outcome and poor-outcome patients diminish over time. In contrast, gray matter volumes in poor-outcome patients continue to decline more rapidly than in patients with good outcome. These patterns are consistent with earlier onset of aging-associated changes in schizophrenia.

Age-related gray matter volume changes in the brain during non-elderly adulthood

Previous magnetic resonance imaging (MRI) studies described consistent age-related gray matter (GM) reductions in the fronto-parietal neocortex, insula and cerebellum in elderly subjects, but not as frequently in limbic/paralimbic structures. However, it is unclear whether such features are already present during earlier stages of adulthood, and if age-related GM changes may follow non-linear patterns at such age range. This voxel-based morphometry study investigated the relationship between GM volumes and age specifically during non-elderly life (18–50 years) in 89 healthy individuals (48 males and 41 females). Voxelwise analyses showed significant (p < 0.05, corrected) negative correlations in the right prefrontal cortex and left cerebellum, and positive correlations (indicating lack of GM loss) in the medial temporal region, cingulate gyrus, insula and temporal neocortex. Analyses using ROI masks showed that age-related dorsolateral prefrontal volume decrements followed non-linear patterns, and were less prominent in females compared to males at this age range. These findings further support for the notion of a heterogeneous and asynchronous pattern of age-related brain morphometric changes, with region-specific non-linear features.

Age-related non-Gaussian diffusion patterns in the prefrontal brain

PURPOSE

To characterize age-related MR diffusion patterns of the prefrontal brain cortex microstructure using a new method for investigating the non-Gaussian behavior of water diffusion called diffusional kurtosis imaging (DKI).

MATERIALS AND METHODS

Measures of mean diffusivity (MD), fractional anisotropy (FA) and mean kurtosis (MK) were compared in the prefrontal brain cortex of 24 healthy volunteers (adolescents, young adults, and elderly) ranging from age 13 to 85 years. A Mann-Whitney test was used to compare subject groups with respect to the diffusion measures, and linear regression was used to characterize the change in each diffusion measure as a function of age.

RESULTS

We found significant age-related changes in the elderly adult group, with increase of MD and decrease of FA.

CONCLUSION

The current study demonstrates distinct mean kurtosis patterns for different age-ranges, with significant age-related correlation for mean kurtosis (MK) and MK peak position, showing that diffusional kurtosis is able to characterize and measure age-related diffusion changes for both grey and white matter, in the developing and aging brain.

Aging

The normal adult brain undergoes considerable morphological changes with aging. Studying these changes is paramount to differentiate normal age-related brain variations from the effects of neurodegenerative diseases affecting brain structure in the elderly. Considerable progress has been made in this research area during the past few decades, given the availability of noninvasive imaging tools such as magnetic resonance (MR). In recent years image acquisition devices, computer technology and software development have also advanced, allowing sophisticated methods for analyzing brain images, at both the macro-and microstructural level. In this article we will review studies assessing the effect of aging on global and regional gray and white matter volume using advanced MR techniques.

Aging of cerebral white matter: a review of MRI findings

BACKGROUND

Cerebral aging is a complex and heterogeneous process that is associated with a high degree of inter-individual variability. Structural magnetic resonance imaging (MRI) can be used to identify and quantify non-disease-related aging of the cerebral white matter.

METHODS

The present article reviews the findings from several MRI techniques, including morphometric approaches, study of white matter hyperintensities, diffusion tensor imaging, and magnetization transfer imaging, that have been used to examine aging of the cerebral white matter. Furthermore, the relationship of MRI indices of white matter integrity to age-related cognitive declines is reported.

RESULTS

A general pattern of age-related preservation and decline emerges indicating that the prefrontal white matter is most susceptible to the influence of age. Studies that combine MRI with cognitive measures suggest that such age-related reductions in white matter integrity may produce a disconnection state that underlies some of the age-related performance declines in age-sensitive cognitive domains.

CONCLUSIONS

White matter aging may contribute to a disconnection state that is associated with declines in episodic memory, executive functions, and information processing speed.

High consistency of regional cortical thinning in aging across multiple samples

Cross-sectional magnetic resonance imaging (MRI) studies of cortical thickness and volume have shown age effects on large areas, but there are substantial discrepancies across studies regarding the localization and magnitude of effects. These discrepancies hinder understanding of effects of aging on brain morphometry, and limit the potential usefulness of MR in research on healthy and pathological age-related brain changes. The present study was undertaken to overcome this problem by assessing the consistency of age effects on cortical thickness across 6 different samples with a total of 883 participants. A surface-based segmentation procedure (FreeSurfer) was used to calculate cortical thickness continuously across the brain surface. The results showed consistent age effects across samples in the superior, middle, and inferior frontal gyri, superior and middle temporal gyri, precuneus, inferior and superior parietal cortices, fusiform and lingual gyri, and the temporo-parietal junction. The strongest effects were seen in the superior and inferior frontal gyri, as well as superior parts of the temporal lobe. The inferior temporal lobe and anterior cingulate cortices were relatively less affected by age. The results are discussed in relation to leading theories of cognitive aging.

Distinctive alterations of the cingulum bundle during aging and Alzheimer's disease

Brain imaging studies have revealed frontal disruption during aging and parieto-temporal disruption during Alzheimer's disease (AD). The present study aims at developing a specific method based on precise anatomical landmarks for assessing the integrity all along the course of the cingulum bundle, so as to determine if it presents the classical aging and AD dissociation. Five regions of interest (ROIs) were placed on fractional anisotropy (FA) maps all along the cingulum in 15 young (Gyoung), 15 70-year-old (Gold), and 15 AD subjects (Galz). An age-related decrease of FA occurred in the anterior part of the bundle. Moreover, a specific alteration of the supero-posterior region of the cingulum during AD was observed since mean FA values as well as mean number of fibers were significantly decreased in Galz compared to Gold and Gyoung. This multiple ROIs placement allows for revealing distinctive alterations of the cingulum bundle during aging and AD, which could constitute the anatomical basis for the distinctive functional disconnection recently described in the literature using functional connectivity at rest.

White matter diffusion alterations in normal women at risk of Alzheimer's disease

Increased white matter mean diffusivity and decreased fractional anisotropy (FA) has been observed in subjects diagnosed with mild cognitive impairment (MCI) and Alzheimer's disease (AD). We sought to determine whether similar alterations of white matter occur in normal individuals at risk of AD. Diffusion tensor images were acquired in 42 cognitively normal right-handed women with both a family history of dementia and at least one apolipoprotein E4 allele. These were compared with images from 23 normal women without either AD risk factor. Group analyses were performed using tract-based spatial statistics. Reduced FA was observed in the fronto-occipital and inferior temporal fasciculi (particularly posteriorly), the splenium of the corpus callosum, subcallosal white matter and the cingulum bundle. These findings demonstrate that specific white matter pathways are altered in normal women at increased risk of AD years before the expected onset of cognitive symptoms.

Disrupted integrity of the fornix is associated with impaired memory organization in schizophrenia

BACKGROUND

The fornix is a major projection of the hippocampus to and from other brain regions. A previous diffusion tensor imaging (DTI) study has reported disrupted integrity of the fornix in patients with schizophrenia. However, functional significance of the DTI abnormalities of the fornix in schizophrenia has not been fully studied yet. We investigated an association between DTI abnormalities of the fornix and impairment of memory organization in schizophrenia.

METHODS

Thirty-one patients with schizophrenia and 65 age- and gender-matched healthy controls underwent DTI, and fractional anisotropy (FA) and mean diffusivity (MD) were measured in cross-sections of fornix tractography. In addition, all of the patients and 32 controls performed a verbal learning task specialized for evaluating memory organization, the verbal memory subscale of the Wechsler Memory Scale-Revised, the category- and letter fluency tests, and the Japanese version of National Adult Reading Test.

RESULTS

Statistically significant reduction of FA and increase of MD were found in the fornix of patients with schizophrenia compared with controls with no significant lateralization. A significant patients-specific correlation was found between increased MD in the left fornix and lower scores on utilization of semantic organization in the verbal learning task. In addition, increased MD in the right fornix showed a patients-specific association with poorer performance on the category fluency test, which indexes organization of long-term semantic memory. These patients-specific correlations, however, were not statistically lateralized to either hemisphere.

CONCLUSIONS

These results indicate that disrupted integrity of the fornix contributes to impaired memory organization in schizophrenia.

Customization of normal data base specific for 3-tesla MRI is mandatory in VSRAD analysis

A voxel-based specific regional analysis system for Alzheimer's disease (VSRAD) was used for quantitative analysis of parahippocampal atropy with 1.5-tesla (T) MRI in a voxel-wise manner. The analysis of images acquired under a different imaging condition provides an error factor that has a calculated value. Clinical application of 3T-MRI is necessary for establishing a normal data base (N-DB) specific for 3T-MRI data, which permits appropriate application of VSRAD. We established an N-DB specific for 3T-MRI for use in VSRAD. The "Z-score of the parahippocampal gyrus" was 0.79 +/- 0.32, and the N-DB of each age group did not have a big deflection when we analyzed a group of physically unimpaired persons in an N-DB specific for 3T-MRI. Therefore, we were able to confirm the validity of the customized N-DB. The "Z-score of the parahippocampal gyrus" was 1.62 +/- 0.47 for the N-DB of VSRAD. The numerical value was high for the group of physically unimpaired persons.

The relationship between diffusion tensor imaging and volumetry as measures of white matter properties

There is still limited knowledge about the relationship between different structural brain parameters, despite huge progress in analysis of neuroimaging data. The aim of the present study was to test the relationship between fractional anisotropy (FA) from diffusion tensor imaging (DTI) and regional white matter (WM) volume. As WM volume has been shown to develop until middle age, the focus was on changes in WM properties in the age range of 40 to 60 years. 100 participants were scanned with magnetic resonance imaging (MRI). Each hemisphere was parcellated into 35 WM regions, and volume, FA, axial, and radial diffusion in each region were calculated. The relationships between age and the regional measures of FA and WM volume were tested, and then FA and WM volume were correlated, corrected for intracranial volume, age, and sex. WM volume was weakly related to age, while FA correlated negatively with age in 26 of 70 regions, caused by a mix of reduced axial and increased radial diffusion with age. 23 relationships between FA and WM volume were found, with seven being positive and sixteen negative. The positive correlations were mainly caused by increased radial diffusion. It is concluded that FA is more sensitive than volume to changes in WM integrity during middle age, and that FA-age correlations probably are related to reduced amount of myelin with increasing age. Further, FA and WM volume are moderately to weakly related and to a large extent sensitive to different characteristics of WM integrity.

Association between a longer duration of illness, age and lower frontal lobe grey matter volume in schizophrenia

The frontal lobe has an extended maturation period and may be vulnerable to the long-term effects of schizophrenia. We tested this hypothesis by studying the relationship between duration of illness (DoI), grey matter (GM) and cerebro-spinal fluid (CSF) volume across the whole brain. Sixty-four patients with schizophrenia and 25 healthy controls underwent structural MRI scanning and neuropsychological assessment. We performed regression analyses in patients to examine the relationship between DoI and GM and CSF volumes across the whole brain, and correlations in controls between age and GM or CSF volume of the regions where GM or CSF volumes were associated with DoI in patients. Correlations were also performed between GM volume in the regions associated with DoI and neuropsychological performance. A longer DoI was associated with lower GM volume in the left dorsomedial prefrontal cortex (PFC), right middle frontal cortex, left fusiform gyrus (FG) and left cerebellum (lobule III). Additionally, age was inversely associated with GM volume in the left dorsomedial PFC in patients, and in the left FG and CSF excess near the left cerebellum in healthy controls. Greater GM volume in the left dorsomedial PFC was associated with better working memory, attention and psychomotor speed in patients. Our findings suggest that the right middle frontal cortex is particularly vulnerable to the long-term effect of schizophrenia illness whereas the dorsomedial PFC, FG and cerebellum are affected by both a long DoI and aging. The effect of illness chronicity on GM volume in the left dorsomedial PFC may be extended to brain structure-neuropsychological function relationships.

Voxel-based analysis derived from fractional anisotropy images of white matter volume changes with aging

Although age-related effects on brain volume have been extensively investigated post mortem and in vivo using magnetic resonance imaging (MRI), regional and temporal patterns of white matter (WM) volume changes with aging are not defined yet. The aim of this study was to assess the topographical distribution of age-related WM volume changes using a recently developed voxel-based method to obtain estimates of WM fiber bundle volumes using diffusion tensor (DT) MRI. Brain conventional and DT MRI were obtained from 84 healthy subjects (mean age=44 years, range=13-70). Linear and non-linear relationships between age and WM fiber bundle volume changes were tested. A negative linear correlation was found between age and WM volume decline in the corona radiata, anterior cingulum, body and crus of the fornix and left superior cerebellar peduncle. A positive linear correlation was found between age and volume increase of the right deep temporal association fibers. The non-linear regression analysis also showed age-related changes of the genu of the corpus callosum and fitted better the volume changes of the right deep temporal association fibers. WM volume decline with age is unevenly distributed across brain regions. Our approach holds promise to gain additional information on the pathological changes associated to neurological disorders of the elderly.