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Published online before print June 23, 2008, 10.1148/radiol.2482070938

(Radiology 2008;248:590.)

A more recent version of this article appeared on August 1, 2008
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© RSNA, 2008

Neuroradiology

Whole-Brain Atrophy Rate and Cognitive Decline: Longitudinal MR Study of Memory Clinic Patients1

Jasper D. Sluimer, MD, Wiesje M. van der Flier, PhD, Giorgos B. Karas, MD, Nick C. Fox, MD, FRCP, Philip Scheltens, MD, PhD, Frederik Barkhof, MD, PhD, and Hugo Vrenken, PhD

1 From the Alzheimer Centre and Department of Diagnostic Radiology (J.D.S., G.B.K., F.B., H.V.), Image Analysis Centre (J.D.S., F.B.), Department of Neurology (W.M.v.d.F., P.S.), and Department of Physics and Medical Technology (J.D.S., H.V.), Vrije Universiteit Medical Centre (VUMC), De Boelelaan 1117, 1007 MB Amsterdam, the Netherlands; and Dementia Research Centre, Institute of Neurology (N.C.F.), University College London, London, England. Received June 1, 2007; revision requested July 31; revision received October 18; accepted December 28; final version accepted February 19, 2008. J.D.S. supported by grant 03514 from the Internationale Stichting Alzheimer Onderzoek and the Image Analysis Center. The Alzheimer Center VUMC is supported by Alzheimer Nederland and Stichting VUMC funds. The clinical database structure was developed with funding from Stichting Dioraphte. Address correspondence to J.D.S. (e-mail: jd.sluimer{at}vumc.nl).

Purpose: To prospectively determine whole-brain atrophy rate in mild cognitive impairment (MCI) and Alzheimer disease (AD) and its association with cognitive decline, and investigate the risk of progression to dementia in initially nondemented patients given baseline brain volume and whole-brain atrophy rate.

Materials and Methods: This study was IRB approved; written informed consent was obtained; and included 65 AD patients (38 women, 27 men; age, 52–81 years), 45 MCI patients (22 women, 23 men; age, 56–80 years), 27 patients with subjective complaints (12 women, 15 men; age, 50–87 years), and 10 healthy controls (six women, four men; age, 53–80 years). Two magnetic resonance (MR) images were acquired at average interval of 1.8 years ± 0.7 (standard deviation). Baseline brain volume and whole-brain atrophy rates were measured on three-dimensional T1-weighted MR images (1.0 T; single slab, 168 sections; matrix size, 256 x 256; field of view, 250 mm; voxel size, 1 x 1 x 1.5 mm; repetition time msec/echo time msec/inversion time msec, 15/7/300; and flip angle, 15°). Associations were assessed by using partial-correlations. Cox proportional hazards models were used to estimate risk of developing dementia.

Results: Baseline brain volume was lowest in AD but did not differ significantly between MCI, subjective complaints, and control groups (P > .38). Whole-brain atrophy rates were higher in AD (–1.9% per year ± 0.9) than MCI (–1.2% per year ± 0.9, P = .003) patients, who had higher whole-brain atrophy rates than patients with subjective complaints (–0.7% per year ± 0.7, P = .03) and controls (–0.5% per year ± 0.5, P = .05). Whole-brain atrophy rate correlated with annualized Mini-Mental State Examination (MMSE) change (r = 0.48, P < .001), while baseline volume did not (r = 0.11, P = .22). Cox models showed that—after correction for age, sex, and baseline MMSE—a higher whole-brain atrophy rate was associated with an increased risk of progression to dementia (highest vs lowest tertile [hazard ratio, 3.6; 95% confidence interval: 1.2, 11.4]).

Conclusion: Whole-brain atrophy rate was strongly associated with cognitive decline. In nondemented participants, a high whole-brain atrophy rate was associated with an increased risk of progression to dementia.

© RSNA, 2008