Stefan J Teipel1,2, Felix Keller1,2, Jochen R Thyrian3, Urs Strohmaier3,4, Attila Altiner5, Wolfgang Hoffmann3,4, Ingo Kilimann1,2. 1. German Center for Neurodegenerative Diseases (DZNE) -Rostock/Greifswald, Rostock, Germany. 2. Department of Psychosomatic Medicine, University of Rostock, Rostock, Germany. 3. German Center for Neurodegenerative Diseases (DZNE) -Rostock/Greifswald, Greifswald, Germany. 4. Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany. 5. Institute of General Practice, University of Rostock, Rostock, Germany.
Abstract
BACKGROUND: Once a patient or a knowledgeable informant has noticed decline in memory or other cognitive functions, initiation of early dementia assessment is recommended. Hippocampus and cholinergic basal forebrain (BF) volumetry supports the detection of prodromal and early stages of Alzheimer's disease (AD) dementia in highly selected patient populations. OBJECTIVE: To compare effect size and diagnostic accuracy of hippocampus and BF volumetry between patients recruited in highly specialized versus primary care and to assess the effect of white matter lesions as a proxy for cerebrovascular comorbidity on diagnostic accuracy. METHODS: We determined hippocampus and BF volumes and white matter lesion load from MRI scans of 71 participants included in a primary care intervention trial (clinicaltrials.gov identifier: NCT01401582) and matched 71 participants stemming from a memory clinic. Samples included healthy controls and people with mild cognitive impairment (MCI), AD dementia, mixed dementia, and non-AD related dementias. RESULTS: Volumetric measures reached similar effect sizes and cross-validated levels of accuracy in the primary care and the memory clinic samples for the discrimination of AD and mixed dementia cases from healthy controls. In the primary care MCI cases, volumetric measures reached only random guessing levels of accuracy. White matter lesions had only a modest effect on effect size and diagnostic accuracy. CONCLUSIONS: Hippocampus and BF volumetry may usefully be employed for the identification of AD and mixed dementia, but the detection of MCI does not benefit from the use of these volumetric markers in a primary care setting.
BACKGROUND: Once a patient or a knowledgeable informant has noticed decline in memory or other cognitive functions, initiation of early dementia assessment is recommended. Hippocampus and cholinergic basal forebrain (BF) volumetry supports the detection of prodromal and early stages of Alzheimer's disease (AD) dementia in highly selected patient populations. OBJECTIVE: To compare effect size and diagnostic accuracy of hippocampus and BF volumetry between patients recruited in highly specialized versus primary care and to assess the effect of white matter lesions as a proxy for cerebrovascular comorbidity on diagnostic accuracy. METHODS: We determined hippocampus and BF volumes and white matter lesion load from MRI scans of 71 participants included in a primary care intervention trial (clinicaltrials.gov identifier: NCT01401582) and matched 71 participants stemming from a memory clinic. Samples included healthy controls and people with mild cognitive impairment (MCI), AD dementia, mixed dementia, and non-AD related dementias. RESULTS: Volumetric measures reached similar effect sizes and cross-validated levels of accuracy in the primary care and the memory clinic samples for the discrimination of AD and mixed dementia cases from healthy controls. In the primary care MCI cases, volumetric measures reached only random guessing levels of accuracy. White matter lesions had only a modest effect on effect size and diagnostic accuracy. CONCLUSIONS: Hippocampus and BF volumetry may usefully be employed for the identification of AD and mixed dementia, but the detection of MCI does not benefit from the use of these volumetric markers in a primary care setting.
Entities:
Keywords:
Alzheimer’s disease; basal forebrain; hippocampus; magnetic resonance imaging; mild cognitive impairment; primary care
Authors: Aku Kaipainen; Olli Jääskeläinen; Yawu Liu; Fanni Haapalinna; Niko Nykänen; Ritva Vanninen; Anne M Koivisto; Valtteri Julkunen; Anne M Remes; Sanna-Kaisa Herukka Journal: J Alzheimers Dis Date: 2020 Impact factor: 4.472
Authors: Sara Fernández-Cabello; Martin Kronbichler; Koene R A Van Dijk; James A Goodman; R Nathan Spreng; Taylor W Schmitz Journal: Brain Date: 2020-03-01 Impact factor: 13.501