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VBM anticipates the rate of progression of Alzheimer disease

A 3-year longitudinal study

From INSERM U610 (S.K., M.S., S.L., B.D.), Paris; IFR-49 (S.K., S.L.), SHFJ, Orsay; e(ye)BRAIN (S.K.), Paris; Research and Resource Memory Centre (M.S., E.G.-G., T.H., B.D.), Service de Neuroradiologie (S.L.), and IFR-70 (B.D.), Groupe Hospitalier Pitié-Salpêtrière, Paris; Center for NeuroImaging Research–CENIR (S.L.), Paris; and Université Pierre et Marie Curie-Paris 6 (S.L., B.D.), Paris, France.

Address correspondence and reprint requests to Dr. Marie Sarazin, Fédération des maladies du Système Nerveux, Research and Resource Memory Centre, Pavillon Paul Castaigne, Hôpital de la Salpêtrière, 47 Bd de l’Hôpital, 75013 Paris marie.sarazin{at}psl.aphp.fr

Objective: To determine whether regional atrophy or neuropsychological factors can predict the rate of decline in patients with mild Alzheimer disease (AD).

Background: Despite important implications for planning the care and treatment strategy, few prognostic factors of severe AD progression are known.

Methods: Twenty-three patients with mild AD were followed up every 6 months over the course of 3 years. At baseline, patients with AD and 18 controls underwent a neuropsychological battery and a brain MRI. At the end of the 3 years, patients with AD were dichotomized into slow decliners (SLD) or fast decliners (FD) groups on the basis of their decline in Mini-Mental State Examination score over time. We compared baseline cognitive performance and imaging data using voxel-based morphometry (VBM).

Results: SLD and FD groups did not differ in age, gender, level of education, mean estimated duration of illness, and standard neuropsychological data at inclusion, except for the Attentional Battery of the Cambridge Neuropsychological Tests Automated Battery (speed processing in shifting condition). VBM comparison between SLD and FD groups demonstrated more gray matter tissue loss in the FD group in the medial occipitoparietal areas, especially in the precuneus, the lingual gyrus, the cuneus, and the surrounding cortex of the parieto-occipital sulcus bilaterally.

Conclusion: Voxel-based morphometry analysis demonstrated that patients who will have a faster decline at 3 years already had a more extensive cortical atrophy than SLD patients, especially in the medial occipitoparietal areas, which was not yet detected by clinical and neuropsychological assessment.

Abbreviations: AD = Alzheimer disease; CANTAB = Cambridge Neuropsychological Tests Automated Battery; CDR = Clinical Dementia Rating; FD = fast decliners; FWHM = full width at half maximum; MCI = mild cognitive impairment; MMSE = Mini-Mental State Examination; MNI = Montreal Neurological Institute; SLD = slow decliners; VBM = voxel-based morphometry.

Editorial, page 2194

e-Pub ahead of print on April 30, 2008, at www.neurology.org.

Supported by INSERM U.610, Ministère de la Santé (PHRC, Principal Investigator: Bruno Dubois), Reunic Prévoyance, Fondation Nationale de Gérontologie, and Institut Fédératif de Recherche 49 (IFR49).

Disclosure: The authors report no disclosures.

Received January 30, 2007. Accepted in final form October 22, 2007.

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