Daniel Ferreira1, Lena Cavallin2,3, Tobias Granberg2,3, Olof Lindberg4, Carlos Aguilar4, Patrizia Mecocci5, Bruno Vellas6, Magda Tsolaki7, Iwona Kłoszewska8, Hilkka Soininen9, Simon Lovestone10, Andrew Simmons11,12,13, Lars-Olof Wahlund4, Eric Westman4. 1. Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Novum, 5th floor, SE-141 86, Stockholm, Sweden. daniel.ferreira.padilla@ki.se. 2. Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. 3. Department of Radiology, Karolinska University Hospital in Huddinge, Huddinge, Sweden. 4. Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Novum, 5th floor, SE-141 86, Stockholm, Sweden. 5. Institute of Gerontology and Geriatrics, University of Perugia, Perugia, Italy. 6. INSERM U 558, University of Toulouse, Toulouse, France. 7. 3rd Department of Neurology, Aristoteleion Panepistimeion Thessalonikis, Thessaloniki, Greece. 8. Medical University of Lodz, Lodz, Poland. 9. University of Eastern Finland, University Hospital of Kuopio, Kuopio, Finland. 10. Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK. 11. Department of Neuroimaging, Institute of Psychiatry, King's College London, London, UK. 12. NIHR Biomedical Research Centre for Mental Health, London, UK. 13. NIHR Biomedical Research Unit for Dementia, London, UK.
Abstract
OBJECTIVES: To validate a visual rating scale of frontal atrophy with quantitative imaging and study its association with clinical status, APOE ε4, CSF biomarkers, and cognition. METHODS: The AddNeuroMed and ADNI cohorts were combined giving a total of 329 healthy controls, 421 mild cognitive impairment patients, and 286 Alzheimer's disease (AD) patients. Thirty-four patients with frontotemporal dementia (FTD) were also included. Frontal atrophy was assessed with the frontal sub-scale of the global cortical atrophy scale (GCA-F) on T1-weighted images. Automated imaging markers of cortical volume, thickness, and surface area were evaluated. Manual tracing was also performed. RESULTS: The GCA-F scale reliably reflects frontal atrophy, with orbitofrontal, dorsolateral, and motor cortices being the regions contributing most to the GCA-F ratings. GCA-F primarily reflects reductions in cortical volume and thickness, although it was able to detect reductions in surface area too. The scale showed significant associations with clinical status and cognition. CONCLUSION: The GCA-F scale may have implications for clinical practice as supportive diagnostic tool for disorders demonstrating predominant frontal atrophy such as FTD and the executive presentation of AD. We believe that GCA-F is feasible for use in clinical routine for the radiological assessment of dementia and other disorders. KEY POINTS: • The GCA-F visual rating scale reliably reflects frontal brain atrophy. • Orbitofrontal, dorsolateral, and motor cortices are the most contributing regions. • GCA-F shows significant associations with clinical status and cognition. • GCA-F may be supportive diagnostic tool for disorders demonstrating predominant frontal atrophy. • GCA-F may be feasible for use in radiological routine.
OBJECTIVES: To validate a visual rating scale of frontal atrophy with quantitative imaging and study its association with clinical status, APOE ε4, CSF biomarkers, and cognition. METHODS: The AddNeuroMed and ADNI cohorts were combined giving a total of 329 healthy controls, 421 mild cognitive impairmentpatients, and 286 Alzheimer's disease (AD) patients. Thirty-four patients with frontotemporal dementia (FTD) were also included. Frontal atrophy was assessed with the frontal sub-scale of the global cortical atrophy scale (GCA-F) on T1-weighted images. Automated imaging markers of cortical volume, thickness, and surface area were evaluated. Manual tracing was also performed. RESULTS: The GCA-F scale reliably reflects frontal atrophy, with orbitofrontal, dorsolateral, and motor cortices being the regions contributing most to the GCA-F ratings. GCA-F primarily reflects reductions in cortical volume and thickness, although it was able to detect reductions in surface area too. The scale showed significant associations with clinical status and cognition. CONCLUSION: The GCA-F scale may have implications for clinical practice as supportive diagnostic tool for disorders demonstrating predominant frontal atrophy such as FTD and the executive presentation of AD. We believe that GCA-F is feasible for use in clinical routine for the radiological assessment of dementia and other disorders. KEY POINTS: • The GCA-F visual rating scale reliably reflects frontal brain atrophy. • Orbitofrontal, dorsolateral, and motor cortices are the most contributing regions. • GCA-F shows significant associations with clinical status and cognition. • GCA-F may be supportive diagnostic tool for disorders demonstrating predominant frontal atrophy. • GCA-F may be feasible for use in radiological routine.
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