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Rajagopal SK, Beltz AM, Hampstead BM, Polk TA. Estimating individual trajectories of structural and cognitive decline in mild cognitive impairment for early prediction of progression to dementia of the Alzheimer's type. Sci Rep 2024; 14:12906. [PMID: 38839800 PMCID: PMC11153588 DOI: 10.1038/s41598-024-63301-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 05/27/2024] [Indexed: 06/07/2024] Open
Abstract
Only a third of individuals with mild cognitive impairment (MCI) progress to dementia of the Alzheimer's type (DAT). Identifying biomarkers that distinguish individuals with MCI who will progress to DAT (MCI-Converters) from those who will not (MCI-Non-Converters) remains a key challenge in the field. In our study, we evaluate whether the individual rates of loss of volumes of the Hippocampus and entorhinal cortex (EC) with age in the MCI stage can predict progression to DAT. Using data from 758 MCI patients in the Alzheimer's Disease Neuroimaging Database, we employ Linear Mixed Effects (LME) models to estimate individual trajectories of regional brain volume loss over 12 years on average. Our approach involves three key analyses: (1) mapping age-related volume loss trajectories in MCI-Converters and Non-Converters, (2) using logistic regression to predict progression to DAT based on individual rates of hippocampal and EC volume loss, and (3) examining the relationship between individual estimates of these volumetric changes and cognitive decline across different cognitive functions-episodic memory, visuospatial processing, and executive function. We find that the loss of Hippocampal volume is significantly more rapid in MCI-Converters than Non-Converters, but find no such difference in EC volumes. We also find that the rate of hippocampal volume loss in the MCI stage is a significant predictor of conversion to DAT, while the rate of volume loss in the EC and other additional regions is not. Finally, individual estimates of rates of regional volume loss in both the Hippocampus and EC, and other additional regions, correlate strongly with individual rates of cognitive decline. Across all analyses, we find significant individual variation in the initial volumes and the rates of changes in volume with age in individuals with MCI. This study highlights the importance of personalized approaches in predicting AD progression, offering insights for future research and intervention strategies.
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Affiliation(s)
| | - Adriene M Beltz
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Benjamin M Hampstead
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Thad A Polk
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
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Phillips ML, Stage EC, Lane KA, Gao S, Risacher SL, Goukasian N, Saykin AJ, Carrillo MC, Dickerson BC, Rabinovici GD, Apostolova LG. Neurodegenerative Patterns of Cognitive Clusters of Early-Onset Alzheimer's Disease Subjects: Evidence for Disease Heterogeneity. Dement Geriatr Cogn Disord 2019; 48:131-142. [PMID: 31901905 PMCID: PMC7031037 DOI: 10.1159/000504341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/24/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Alzheimer's disease (AD) with onset before 65 (early-onset AD [EOAD]) occurs in approximately 6% of cases and can affect nonmemory domains. Here, we analyze patterns of impairment in amnestic EOAD individuals using data-driven statistical analyses. METHODS Cognitive data of 146 EOAD subjects were Z-normalized to 395 cognitively normal (CN) individuals. Domain-averaged Z-scores were adjusted for age, sex, and education followed by Wald cluster analysis of residuals. Magnetic resonance imaging and positron emission tomography comparisons of EOAD clusters to age-matched CN were done using Statistic Parametric Mapping 8. Cluster-level-family-wise error (p < 0.05) correction was applied. Mixed-effect models were used to compute longitudinal change across clusters. RESULTS Scree plot using the pseudo-T-squared suggested a 4-cluster solution. Cluster 1 (memory-predominant impairment) showed atrophy/hypometabolism in medial/lateral temporal, lateral parietal, and posterior cingulate regions. Cluster 2 (memory/visuospatial-predominant) showed atrophy/hypometabolism of medial temporal, temporoparietal, and frontal cortices. Cluster 3 (memory, language, and executive function) and Cluster 4 (globally impaired) manifested atrophy and hypometabolism throughout the brain. Longitudinally between-cluster differences in the visuospatial and language/executive domains were significant, suggesting phenotypic variation. CONCLUSION We observed significant heterogeneity in cognitive presentation among amnestic EOAD subjects and patterns of atrophy/hypometabolism in each cluster in agreement with the observed cognitive phenotype.
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Affiliation(s)
- Meredith L. Phillips
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, IN, USA
| | - Eddie C. Stage
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA,Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kathleen A. Lane
- Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA,Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sujuan Gao
- Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA,Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Shannon L. Risacher
- Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA,Department of Radiology and Imaging Sciences, Center for Neuroimaging, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Naira Goukasian
- University of Vermont College of Medicine, Burlington, VT, USA
| | - Andrew J. Saykin
- Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA,Department of Radiology and Imaging Sciences, Center for Neuroimaging, Indiana University School of Medicine, Indianapolis, IN, USA,Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA,Indiana University Network Science Institute, Indianapolis, IN, USA
| | | | | | | | - Liana G. Apostolova
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA,Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA,Department of Radiology and Imaging Sciences, Center for Neuroimaging, Indiana University School of Medicine, Indianapolis, IN, USA,Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA,Indiana University Network Science Institute, Indianapolis, IN, USA
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Lemos R, Marôco J, Simões MR, Santana I. Construct and diagnostic validities of the Free and Cued Selective Reminding Test in the Alzheimer's disease spectrum. J Clin Exp Neuropsychol 2016; 38:913-24. [PMID: 27187087 DOI: 10.1080/13803395.2016.1176996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The Free and Cued Selective Reminding Test (FCSRT) is a memory test that controls attention and acquisition, by providing category cues in the learning process. Because it enables an assessment of memory not confounded by normal age-related changes in cognition and a high accuracy on Alzheimer's disease (AD) evaluation, it has been suggested by the International Working Group on AD. Our aim was to assess the construct related validity of the FCSRT in the AD spectrum disorders. METHOD Patients were classified in two groups according to standard criteria: amnestic mild cognitive impairment (n = 100) and AD (n = 70). A matched control group (n = 101) of cognitively healthy subjects was included. The factorial structure of two models and respective construct and diagnostic validities were analyzed. RESULTS Both models revealed adequate fit values. The appropriated convergent validity and the lack of discriminant validity support the two factors as measuring the same construct (memory ability). The recalls of the FCSRT enabled high classification accuracy and diagnostic validity for both pathological groups. CONCLUSIONS This study represents a novel contribution regarding the adequacy of the FCSRT in terms of construct and diagnostic validities and shows the interest of including both immediate (learning) and delayed (retention) recalls. It gives also new possibilities regarding the use of the FCSRT in the memory assessment of AD spectrum disorders.
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Affiliation(s)
- Raquel Lemos
- a Faculty of Psychology and Educational Sciences , University of Coimbra , Coimbra , Portugal.,b Visual Neuroscience Laboratory, Institute of Biomedical Research in Light and Image, Faculty of Medicine , University of Coimbra , Coimbra , Portugal
| | - João Marôco
- c Psychology and Health Research Unit (UIPES) & Department of Psychological Sciences , ISPA-Instituto Universitário , Lisbon , Portugal
| | - Mário R Simões
- d Faculty of Psychology and Educational Sciences , University of Coimbra , Coimbra , Portugal
| | - Isabel Santana
- e Faculty of Medicine , University of Coimbra , Coimbra , Portugal.,f Neurology Department of the Coimbra Hospital and University Center , Coimbra , Portugal
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Lemos R, Afonso A, Martins C, Waters JH, Blanco FS, Simões MR, Santana I. Selective Reminding and Free and Cued Selective Reminding in Mild Cognitive Impairment and Alzheimer Disease. APPLIED NEUROPSYCHOLOGY-ADULT 2015; 23:85-93. [PMID: 26375308 DOI: 10.1080/23279095.2015.1012761] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The Selective Reminding Test (SRT) and the Free and Cued Selective Reminding Test (FCSRT) are multitrial memory tests that use a common "selective reminding" paradigm that aims to facilitate learning by presenting only the missing words from the previous recall trial. While in the FCSRT semantic cues are provided to elicit recall, in the SRT, participants are merely reminded of the missing items by repeating them. These tests have been used to assess age-related memory changes and to predict dementia. The performance of healthy elders on these tests has been compared before, and results have shown that twice as many words were retrieved from long-term memory in the FCSRT compared with the SRT. In this study, we compared the tests' properties and their accuracy in discriminating amnestic mild cognitive impairment (aMCI; n = 20) from Alzheimer disease (AD; n = 18). Patients with AD performed significantly worse than patients with aMCI on both tests. The percentage of items recalled during the learning trials was significantly higher for the FCSRT in both groups, and a higher number of items were later retrieved, showing the benefit of category cueing. Our key finding was that the FCSRT showed higher accuracy in discriminating patients with aMCI from those with AD.
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Affiliation(s)
- Raquel Lemos
- a Visual Neuroscience Laboratory, Institute of Biomedical Research in Light and Image, Faculty of Medicine , University of Coimbra , Coimbra , Portugal.,b Faculty of Psychology and Educational Sciences , University of Coimbra , Coimbra , Portugal
| | - Ana Afonso
- b Faculty of Psychology and Educational Sciences , University of Coimbra , Coimbra , Portugal
| | - Cristina Martins
- c Faculty of Humanities , University of Coimbra , Coimbra , Portugal
| | - James H Waters
- d Private Practice (Clinical and Forensic Psychology and Neuropsychology) , Boulder , Colorado
| | - Filipe Sobral Blanco
- e Neurology Department , Centro Hospitalar e Universitário de Coimbra , Coimbra , Portugal
| | - Mário R Simões
- b Faculty of Psychology and Educational Sciences , University of Coimbra , Coimbra , Portugal
| | - Isabel Santana
- e Neurology Department , Centro Hospitalar e Universitário de Coimbra , Coimbra , Portugal.,f Faculty of Medicine , University of Coimbra , Coimbra , Portugal
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Lemos R, Marôco J, Simões MR, Santiago B, Tomás J, Santana I. The free and cued selective reminding test for predicting progression to Alzheimer's disease in patients with mild cognitive impairment: A prospective longitudinal study. J Neuropsychol 2015; 11:40-55. [PMID: 26058529 DOI: 10.1111/jnp.12075] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 05/06/2015] [Indexed: 12/01/2022]
Abstract
Amnestic mild cognitive impairment (aMCI) patients carry a greater risk of conversion to Alzheimer's disease (AD). Therefore, the International Working Group (IWG) on AD aims to consider some cases of aMCI as symptomatic prodromal AD. The core diagnostic marker of AD is a significant and progressive memory deficit, and the Free and Cued Selective Reminding Test (FCSRT) was recommended by the IWG to test memory in cases of possible prodromal AD. This study aims to investigate whether the performance on the FCSRT would enhance the ability to predict conversion to AD in an aMCI group. A longitudinal study was conducted on 88 aMCI patients, and neuropsychological tests were analysed on the relative risk of conversion to AD. During follow-up (23.82 months), 33% of the aMCI population converted to AD. An impaired FCSRT TR was significantly associated with the risk of conversion to dementia, with a mean time to conversion of 25 months. The FCSRT demonstrates utility for detecting AD at its prodromal stage, thus supporting its use as a valid clinical marker.
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Affiliation(s)
- Raquel Lemos
- Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal.,Visual Neuroscience Laboratory, Institute of Biomedical Research in Light and Image, Faculty of Medicine, University of Coimbra, Portugal
| | - João Marôco
- Psychology and Health Research Unit (UIPES), Department of Psychological Sciences, ISPA - Instituto Universitário, Lisboa, Portugal
| | - Mário R Simões
- Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal
| | - Beatriz Santiago
- Neurology Department of the Coimbra Hospital and University Center, Portugal
| | - José Tomás
- Neurology Department of the Coimbra Hospital and University Center, Portugal
| | - Isabel Santana
- Neurology Department of the Coimbra Hospital and University Center, Portugal.,Faculty of Medicine, University of Coimbra, Portugal
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Freitas S, Prieto G, Simões MR, Santana I. Scaling Cognitive Domains of the Montreal Cognitive Assessment: An Analysis Using the Partial Credit Model. Arch Clin Neuropsychol 2015; 30:435-47. [PMID: 25944337 DOI: 10.1093/arclin/acv027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2015] [Indexed: 11/13/2022] Open
Abstract
The psychometric properties of the Montreal Cognitive Assessment (MoCA) were examined by using the Partial Credit Model. The study sample included 897 participants who were distributed into two main subgroups: (I) the clinical group (90 patients with Mild Cognitive Impairment, 90 patients with Alzheimer's disease, 33 patients with Frontotemporal Dementia, and 34 patients with Vascular dementia, whose diagnoses were previously established according to a consensus that was reached by a multidisciplinary team, based on the international criteria) and (II) the healthy group (composed of 650 cognitively healthy community dwellers). The results show (i) an overall good fit for both the items and the persons' values, (ii) high variability for the cognitive performance level of the cognitive domains (ranging between 1.90 and -3.35, where "Short-term Memory" was the most difficult item and "Spatial Orientation" was the easiest item) and between the subjects on the scale, (iii) high reliability for the estimation of the persons' values, (iv) good discriminant validity and high diagnostic utility, and (v) a minimal differential item functioning effect related to of pathology, gender, age, and educational level. MoCA and its cognitive domains are suitable measures to use for screening the cognitive status of cognitively healthy subjects and patients with cognitive impairment.
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Affiliation(s)
- Sandra Freitas
- Centre for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal Centro de Investigação do Núcleo de Estudos e Intervenção Cognitivo Comportamental (CINEICC), University of Coimbra, Coimbra, Portugal Psychological Assessment Lab., Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Gerardo Prieto
- Departamento de Psicología Básica, Psicobiología y Metodología de las Ciencias del Comportamiento, Universidad de Salamanca, Salamanca, Spain
| | - Mário R Simões
- Centro de Investigação do Núcleo de Estudos e Intervenção Cognitivo Comportamental (CINEICC), University of Coimbra, Coimbra, Portugal Psychological Assessment Lab., Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Isabel Santana
- Centre for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Lemos R, Simões MR, Santiago B, Santana I. The free and cued selective reminding test: Validation for mild cognitive impairment and
A
lzheimer's disease. J Neuropsychol 2014; 9:242-57. [DOI: 10.1111/jnp.12048] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 03/28/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Raquel Lemos
- Faculty of Psychology and Educational Sciences University of Coimbra Portugal
- Neurology Department of the Coimbra Hospital and Universitary Center CoimbraPortugal
| | - Mário R. Simões
- Faculty of Psychology and Educational Sciences University of Coimbra Portugal
| | - Beatriz Santiago
- Neurology Department of the Coimbra Hospital and Universitary Center CoimbraPortugal
| | - Isabel Santana
- Neurology Department of the Coimbra Hospital and Universitary Center CoimbraPortugal
- Faculty of Medicine University of Coimbra Portugal
- Center for Neuroscience and Cell Biology University of Coimbra Portugal
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Freitas S, Prieto G, Simões MR, Santana I. Psychometric Properties of the Montreal Cognitive Assessment (MoCA): An Analysis Using the Rasch Model. Clin Neuropsychol 2014; 28:65-83. [DOI: 10.1080/13854046.2013.870231] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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TeLPI Performance in Subjects With Mild Cognitive Impairment and Alzheimer Disease. Alzheimer Dis Assoc Disord 2013; 27:324-9. [DOI: 10.1097/wad.0b013e31827bdc8c] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lee LK, Shahar S, Chin AV, Yusoff NAM. Docosahexaenoic acid-concentrated fish oil supplementation in subjects with mild cognitive impairment (MCI): a 12-month randomised, double-blind, placebo-controlled trial. Psychopharmacology (Berl) 2013; 225:605-12. [PMID: 22932777 DOI: 10.1007/s00213-012-2848-0] [Citation(s) in RCA: 136] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 08/08/2012] [Indexed: 10/27/2022]
Abstract
RATIONALE Epidemiological studies have suggested a beneficial effect of fish oil supplementation in halting the initial progression of Alzheimer's disease. However, it remains unclear whether fish oil affects cognitive function in older people with mild cognitive impairment (MCI). OBJECTIVES This study investigated the effects of fish oil supplementation on cognitive function in elderly person with MCI. METHODS This was a 12-month, randomised, double-blind, placebo-controlled study using fish oil supplementation with concentrated docosahexaenoic acid (DHA). Thirty six low-socioeconomic-status elderly subjects with MCI were randomly assigned to receive either concentrated DHA fish oil (n = 18) or placebo (n = 18) capsules. The changes of memory, psychomotor speed, executive function and attention, and visual-constructive skills were assessed using cognitive tests. Secondary outcomes were safety and tolerability of the DHA concentrate. RESULTS The fish oil group showed significant improvement in short-term and working memory (F = 9.890; ηp (2) = 0.254; p < 0.0001), immediate verbal memory (F = 3.715; ηp (2) = 0.114; p < 0.05) and delayed recall capability (F = 3.986; ηp (2) = 0.121; p < 0.05). The 12-month change in memory (p < 0.01) was significantly better in the fish oil group. Fish oil consumption was well tolerated, and the side effects were minimal and self-limiting. CONCLUSIONS This study suggested the potential role of fish oil to improve memory function in MCI subjects. Studies with larger sample sizes, longer intervention periods, different fish oil dosages and genetic determinations should be investigated before definite recommendations can be made.
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Affiliation(s)
- Lai Kuan Lee
- Nutrition Science Program, School of Health Care Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Freitas S, Simoes MR, Alves L, Santana I. Montreal Cognitive Assessment: Influence of Sociodemographic and Health Variables. Arch Clin Neuropsychol 2012; 27:165-75. [DOI: 10.1093/arclin/acr116] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Biomarkers of Alzheimer's disease (AD) are increasingly important. All modern AD therapeutic trials employ AD biomarkers in some capacity. In addition, AD biomarkers are an essential component of recently updated diagnostic criteria for AD from the National Institute on Aging--Alzheimer's Association. Biomarkers serve as proxies for specific pathophysiological features of disease. The 5 most well established AD biomarkers include both brain imaging and cerebrospinal fluid (CSF) measures--cerebrospinal fluid Abeta and tau, amyloid positron emission tomography (PET), fluorodeoxyglucose (FDG) positron emission tomography, and structural magnetic resonance imaging (MRI). This article reviews evidence supporting the position that MRI is a biomarker of neurodegenerative atrophy. Topics covered include methods of extracting quantitative and semiquantitative information from structural MRI; imaging-autopsy correlation; and evidence supporting diagnostic and prognostic value of MRI measures. Finally, the place of MRI in a hypothetical model of temporal ordering of AD biomarkers is reviewed.
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Freitas S, Simões MR, Alves L, Santana I. Montreal Cognitive Assessment (MoCA): Normative study for the Portuguese population. J Clin Exp Neuropsychol 2011; 33:989-96. [DOI: 10.1080/13803395.2011.589374] [Citation(s) in RCA: 176] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sandra Freitas
- a Psychological Assessment Department , Faculty of Psychology and Educational Sciences, University of Coimbra , Coimbra, Portugal
| | - Mário R. Simões
- a Psychological Assessment Department , Faculty of Psychology and Educational Sciences, University of Coimbra , Coimbra, Portugal
| | - Lara Alves
- a Psychological Assessment Department , Faculty of Psychology and Educational Sciences, University of Coimbra , Coimbra, Portugal
| | - Isabel Santana
- b Faculty of Medicine, University of Coimbra , Coimbra, Portugal
- c Neurology Department , Coimbra University Hospital , Coimbra, Portugal
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Role of structural MRI in Alzheimer's disease. ALZHEIMERS RESEARCH & THERAPY 2010; 2:23. [PMID: 20807454 PMCID: PMC2949589 DOI: 10.1186/alzrt47] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Accepted: 08/24/2010] [Indexed: 01/21/2023]
Abstract
Atrophy measured on structural magnetic resonance imaging (sMRI) is a powerful biomarker of the stage and intensity of the neurodegenerative aspect of Alzheimer's disease (AD) pathology. In this review, we will discuss the role of sMRI as an AD biomarker by summarizing (a) the most commonly used methods to extract information from sMRI images, (b) the different roles in which sMRI can be used as an AD biomarker, and (c) comparisons of sMRI with other major AD biomarkers.
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Apostolova LG, Morra JH, Green AE, Hwang KS, Avedissian C, Woo E, Cummings JL, Toga AW, Jack CR, Weiner MW, Thompson PM. Automated 3D mapping of baseline and 12-month associations between three verbal memory measures and hippocampal atrophy in 490 ADNI subjects. Neuroimage 2010; 51:488-99. [PMID: 20083211 PMCID: PMC2847034 DOI: 10.1016/j.neuroimage.2009.12.125] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 12/01/2009] [Accepted: 12/16/2009] [Indexed: 11/16/2022] Open
Abstract
We used a previously validated automated machine learning algorithm based on adaptive boosting to segment the hippocampi in baseline and 12-month follow-up 3D T1-weighted brain MRIs of 150 cognitively normal elderly (NC), 245 mild cognitive impairment (MCI) and 97 Dementia of the Alzheimer's type (DAT) ADNI subjects. Using the radial distance mapping technique, we examined the hippocampal correlates of delayed recall performance on three well-established verbal memory tests--ADAScog delayed recall (ADAScog-DR), the Rey Auditory Verbal Learning Test -DR (AVLT-DR) and Wechsler Logical Memory II-DR (LM II-DR). We observed no significant correlations between delayed recall performance and hippocampal radial distance on any of the three verbal memory measures in NC. All three measures were associated with hippocampal volumes and radial distance in the full sample and in the MCI group at baseline and at follow-up. In DAT we observed stronger left-sided associations between hippocampal radial distance, LM II-DR and ADAScog-DR both at baseline and at follow-up. The strongest linkage between memory performance and hippocampal atrophy in the MCI sample was observed with the most challenging verbal memory test-the AVLT-DR, as opposed to the DAT sample where the least challenging test the ADAScog-DR showed strongest associations with the hippocampal structure. After controlling for baseline hippocampal atrophy, memory performance showed regionally specific associations with hippocampal radial distance in predominantly CA1 but also in subicular distribution.
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Affiliation(s)
- Liana G Apostolova
- Department of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, USA.
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Validation studies of the Portuguese experimental version of the Montreal Cognitive Assessment (MoCA): confirmatory factor analysis. J Neurol 2009; 257:728-34. [DOI: 10.1007/s00415-009-5399-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Revised: 11/09/2009] [Accepted: 11/12/2009] [Indexed: 12/31/2022]
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Abstract
Problems with memory are a very common complaint in the elderly and are not synonymous with dementia. Some degree of cognitive decline, manifested as greater difficulty in learning and retrieving new information for instance, develops with normal aging. Thus many older patients do not perform at the same level they did when they were younger but they do perform well when compared to their peers. For many, cognitive change ends at this stage and they proceed to lead normal, healthy, dementia-free lives.The cohort that has cognitive changes beyond what is expected in normal aging but does not yet meet criteria for dementia concerns clinicians greatly as many of these patients eventually become demented. These patients usually go through a latent stage in which neurodegenerative pathology silently spreads in the brain. Once there is enough pathological burden, cognitive decline beyond what is expected for normal aging can be detected by formal neuropsychological testing. Frequently such patients go through a state called mild cognitive impairment (MCI). In this state patients are still functionally intact and live independently, but show cognitive impairment relative to the age- and education-adjusted norms.The MCI state in itself is a prominent risk factor for developing dementia. Most patients with amnestic MCI develop Alzheimer’s disease (AD) dementia over time. At six years, as many as 80% progress to AD. Thus, MCI is a very important topic of research and an increasingly important topic of clinical care.
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Apostolova LG, Cummings JL. Neuropsychiatric manifestations in mild cognitive impairment: a systematic review of the literature. Dement Geriatr Cogn Disord 2008; 25:115-26. [PMID: 18087152 DOI: 10.1159/000112509] [Citation(s) in RCA: 260] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Mild cognitive impairment (MCI) is an etiologically heterogeneous condition that is characterized by cognitive changes without impairment of activities of daily living and insufficient to represent dementia. MCI is an important risk state for dementia. Neuropsychiatric symptoms may be present in MCI. METHODS We executed a PubMed search for articles on the neuropsychiatric manifestations in MCI and reviewed their findings. RESULTS Behavioral abnormalities are reported in 35-75% of MCI patients with the most common being depression, apathy, anxiety and irritability. The observed variability in symptom prevalence can be explained by the different sampling methods, MCI diagnostic criteria and behavioral instruments used. There is a compelling body of evidence that MCI patients with behavioral features are more prone to develop Alzheimer's disease (AD) than patients without these features. CONCLUSIONS Neuropsychiatric symptoms are common features of MCI. The behavioral changes observed in MCI are similar to those of AD and may help identify the subgroup of MCI patients with prodromal AD. Large prospective longitudinal studies would greatly contribute to our understanding of the epidemiology, diagnostic and prognostic value of the neuropsychiatric features in MCI.
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Apostolova LG, Thompson PM. Mapping progressive brain structural changes in early Alzheimer's disease and mild cognitive impairment. Neuropsychologia 2007; 46:1597-612. [PMID: 18395760 PMCID: PMC2713100 DOI: 10.1016/j.neuropsychologia.2007.10.026] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Revised: 10/03/2007] [Accepted: 10/31/2007] [Indexed: 10/22/2022]
Abstract
Alzheimer's disease (AD), the most common neurodegenerative disorder of the elderly, ranks third in health care cost after heart disease and cancer. Given the disproportionate aging of the population in all developed countries, the socio-economic impact of AD will continue to rise. Mild cognitive impairment (MCI), a transitional state between normal aging and dementia, carries a four- to sixfold increased risk of future diagnosis of dementia. As complete drug-induced reversal of AD symptoms seems unlikely, researchers are now focusing on the earliest stages of AD where a therapeutic intervention is likely to realize the greatest impact. Recently neuroimaging has received significant scientific consideration as a promising in vivo disease-tracking modality that can also provide potential surrogate biomarkers for therapeutic trials. While several volumetric techniques laid the foundation of the neuroimaging research in AD and MCI, more precise computational anatomy techniques have recently become available. This new technology detects and visualizes discrete changes in cortical and hippocampal integrity and tracks the spread of AD pathology throughout the living brain. Related methods can visualize regionally specific correlations between brain atrophy and important proxy measures of disease such as neuropsychological tests, age of onset or factors that may influence disease progression. We describe extensively validated cortical and hippocampal mapping techniques that are sensitive to clinically relevant changes even in the single individual, and can identify group differences in epidemiological studies or clinical treatment trials. We give an overview of some recent neuroimaging advances in AD and MCI and discuss strengths and weaknesses of the various analytic approaches.
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Affiliation(s)
- Liana G Apostolova
- Department of Neurology, David Geffen School of Medicine, UCLA, CA, United States.
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