Imaging Alzheimer's disease

Linking hippocampal structure and function to memory performance in an aging population

BACKGROUND

Hippocampal atrophy and reductions in basal cerebral blood volume (CBV), a hemodynamic correlate of brain function, occur with cognitive impairment in Alzheimer disease, but whether these are early or late changes remains unclear. Magnetic resonance imaging is used to assess structure and function in the hippocampal formation.

OBJECTIVE

To estimate differences in the associations of hippocampal and entorhinal cortex volumes and CBV with memory function in the early and late stages of cognitive impairment by relating these measures to memory function in persons with and without dementia who underwent detailed brain imaging and neuropsychological assessment.

DESIGN

Multivariate regression analyses were used to relate entorhinal cortex volume, entorhinal cortex CBV, hippocampal volume, and hippocampal CBV to measurements of memory performance. The same measures were related to language function as a reference cognitive domain.

SETTING

Community-based cohort.

PARTICIPANTS

Two hundred thirty-one elderly Medicare recipients (aged > or =65 years) residing in northern Manhattan, New York.

MAIN OUTCOME MEASURES

Values for entorhinal cortex volume, hippocampal volume, entorhinal cortex CBV, and hippocampal CBV and their relation to memory performance.

RESULTS

No association was noted between entorhinal cortex volume or hippocampal CBV and memory. Decreased hippocampal volume was strongly associated with worse performance in total recall, and lower entorhinal cortex CBV was associated with lower performance in delayed recall. Excluding persons with Alzheimer disease, the association of entorhinal cortex CBV with memory measures was stronger, whereas the association between hippocampal volume and total recall became nonsignificant.

CONCLUSIONS

In the early stages of Alzheimer disease or in persons without dementia with worse memory ability, functional and metabolic hippocampal hypofunction contributes to memory impairment, whereas in the later stages, functional and structural changes play a role.

Nanoimaging in protein-misfolding and -conformational diseases

Protein misfolding and the subsequent assembly of protein molecules into aggregates of various morphologies represent common mechanisms that link a number of important human diseases, known as protein-misfolding diseases. The current list of these disorders includes (but is not limited to) numerous neurodegenerative diseases, cataracts, arthritis, medullary carcinoma of the thyroid, late-onset diabetes mellitus, symptomatic (hemodialysis-related) beta(2)-microglobulin amyloidosis, arthritis and many other systemic, localized and familial amyloidoses. Progress in understanding protein-misfolding pathologies and in potential rational drug design aimed at the inhibition or reversal of protein aggregation depends on our ability to study the details of the misfolding process, to follow the aggregation process and to see and analyze the structure and mechanical properties of the aggregated particles. Nanoimaging provides a method to monitor the aggregation process, visualize protein aggregates and analyze their properties and provides fundamental knowledge of key factors that lead to protein misfolding and self-assembly in various protein-misfolding pathologies, therefore advancing medicine dramatically.

Quantitative MR imaging in Alzheimer disease

Alzheimer disease (AD) is the most common type of dementia. It currently affects approximately 4 million people in the United States. AD is a progressive neurodegenerative disorder characterized by the gradual deposition of neuritic plaques and neurofibrillary tangles in the brain, which is thought to occur decades before the onset of clinical symptoms. Identification of people at risk before the clinical appearance of dementia has become a priority due to the potential benefits of therapeutic intervention. Although atrophy of medial temporal lobe structures has been shown to correlate with progression of AD, a growing number of recent reports have indicated that such atrophy may not be specific to AD. To improve diagnostic specificity, new quantitative magnetic resonance (MR) imaging methods are being developed that exploit known pathogenic mechanisms exclusive to AD. This article reviews the MR techniques that are currently available for the diagnostic assessment of AD.

Technology Insight: imaging amyloid plaques in the living brain with positron emission tomography and MRI

Alois Alzheimer first imaged amyloid plaques in 1906 by examining dead tissue under the microscope, but their clinical significance has remained undetermined. Now, nearly a century later, investigators are beginning to image amyloid plaques in living brains using both positron emission tomography and MRI. In this article, we review the studies that report on these recent technical advances, and discuss their potential importance in clarifying the diagnostic and pathogenic relevance of amyloid plaques to Alzheimer's disease.