Young Noh1, Seun Jeon1, Jong Min Lee2, Sang Won Seo1, Geon Ha Kim1, Hanna Cho1, Byoung Seok Ye1, Cindy W Yoon1, Hee Jin Kim1, Juhee Chin1, Kee Hyung Park1, Kenneth M Heilman1, Duk L Na2. 1. From the Department of Neurology (Y.N., K.H.P.), Gachon University Gil Medical Center, Incheon; Department of Biomedical Engineering (S.J., J.M.L.), Hanyang University, Seoul; Department of Neurology (S.W.S., H.J.K., J.C., D.L.N.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; Department of Neurology (G.H.K.), Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul; Department of Neurology (H.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul; Department of Neurology (B.S.Y.), Yonsei University College of Medicine, Seoul; Department of Neurology (C.W.Y.), Inha University Hospital, Inha University School of Medicine, Incheon, Korea; and Department of Neurology (K.M.H.), University of Florida and Veterans Affairs Medical Center, Gainesville. 2. From the Department of Neurology (Y.N., K.H.P.), Gachon University Gil Medical Center, Incheon; Department of Biomedical Engineering (S.J., J.M.L.), Hanyang University, Seoul; Department of Neurology (S.W.S., H.J.K., J.C., D.L.N.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; Department of Neurology (G.H.K.), Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul; Department of Neurology (H.C.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul; Department of Neurology (B.S.Y.), Yonsei University College of Medicine, Seoul; Department of Neurology (C.W.Y.), Inha University Hospital, Inha University School of Medicine, Incheon, Korea; and Department of Neurology (K.M.H.), University of Florida and Veterans Affairs Medical Center, Gainesville. dukna@skku.edu ljm@hanyang.ac.kr.
Abstract
OBJECTIVE: Because the signs associated with dementia due to Alzheimer disease (AD) can be heterogeneous, the goal of this study was to use 3-dimensional MRI to examine the various patterns of cortical atrophy that can be associated with dementia of AD type, and to investigate whether AD dementia can be categorized into anatomical subtypes. METHODS: High-resolution T1-weighted volumetric MRIs were taken of 152 patients in their earlier stages of AD dementia. The images were processed to measure cortical thickness, and hierarchical agglomerative cluster analysis was performed using Ward's clustering linkage. The identified clusters of patients were compared with an age- and sex-matched control group using a general linear model. RESULTS: There were several distinct patterns of cortical atrophy and the number of patterns varied according to the level of cluster analyses. At the 3-cluster level, patients were divided into (1) bilateral medial temporal-dominant atrophy subtype (n = 52, ∼ 34.2%), (2) parietal-dominant subtype (n = 28, ∼ 18.4%) in which the bilateral parietal lobes, the precuneus, along with bilateral dorsolateral frontal lobes, were atrophic, and (3) diffuse atrophy subtype (n = 72, ∼ 47.4%) in which nearly all association cortices revealed atrophy. These 3 subtypes also differed in their demographic and clinical features. CONCLUSIONS: This cluster analysis of cortical thickness of the entire brain showed that AD dementia in the earlier stages can be categorized into various anatomical subtypes, with distinct clinical features.
OBJECTIVE: Because the signs associated with dementia due to Alzheimer disease (AD) can be heterogeneous, the goal of this study was to use 3-dimensional MRI to examine the various patterns of cortical atrophy that can be associated with dementia of AD type, and to investigate whether AD dementia can be categorized into anatomical subtypes. METHODS: High-resolution T1-weighted volumetric MRIs were taken of 152 patients in their earlier stages of AD dementia. The images were processed to measure cortical thickness, and hierarchical agglomerative cluster analysis was performed using Ward's clustering linkage. The identified clusters of patients were compared with an age- and sex-matched control group using a general linear model. RESULTS: There were several distinct patterns of cortical atrophy and the number of patterns varied according to the level of cluster analyses. At the 3-cluster level, patients were divided into (1) bilateral medial temporal-dominant atrophy subtype (n = 52, ∼ 34.2%), (2) parietal-dominant subtype (n = 28, ∼ 18.4%) in which the bilateral parietal lobes, the precuneus, along with bilateral dorsolateral frontal lobes, were atrophic, and (3) diffuse atrophy subtype (n = 72, ∼ 47.4%) in which nearly all association cortices revealed atrophy. These 3 subtypes also differed in their demographic and clinical features. CONCLUSIONS: This cluster analysis of cortical thickness of the entire brain showed that AD dementia in the earlier stages can be categorized into various anatomical subtypes, with distinct clinical features.
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