Patterns of longitudinal cortical atrophy over 3 years in empirically derived MCI subtypes
Patterns of longitudinal cortical atrophy over 3 years in empirically derived MCI subtypes
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DOI：
10.1212/wnl.0000000000009462
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发表时间：
2020-06-16
期刊：
影响因子：
9.9
通讯作者：
McDonald, Carrie R.
中科院分区：
文献类型：
--
作者：
Edmonds, Emily C.;Weigand, Alexandra J.;McDonald, Carrie R.
目的我们先前通过阿尔茨海默病神经影像学倡议（ADNI）中的聚类分析确定了4种经验性轻度认知障碍（MCI）亚型，并证明了基线时皮质变薄模式与每种认知亚型之间的高度对应性。我们的目的是确定我们的MCI亚型是否表现出独特的纵向萎缩模式。方法ADNI参与者（295例MCI和134例认知正常[CN]）每年接受结构MRI和神经心理学评估。一般线性模型比较了每个MCI亚型和CN组之间皮质萎缩率的顶点差异。线性混合模型检查了3年内感兴趣的脑叶区域内皮质萎缩的轨迹。结果与CN组相比，遗忘型MCI（记忆缺陷）患者最初表现出更大的内侧颞叶区域萎缩率，随着时间的推移变得更广泛。那些有命名/记忆障碍的MCI（命名/记忆缺陷）的人表现出更大的萎缩率，主要集中在颞叶区域。混合MCI（所有认知领域的损害）组在所有时间点的广泛区域中显示出更大的萎缩率。尽管通过常规诊断标准诊断为MCI，但在基线时具有完整神经心理学表现和正常皮质厚度的群集衍生正常组在3年内继续显示正常认知和最小皮质萎缩。结论ADNI的遗忘型MCI样本产生了更精确的认知亚型，具有独特的纵向皮质萎缩率。这些新的MCI亚型可靠地反映了潜在的萎缩，减少了假阳性诊断错误，并改善了临床病程的预测。这些改进对临床试验参与者的选择以及为诊断为MCI的个体提供更精确的风险评估具有意义。
Objective We previously identified 4 empirically derived mild cognitive impairment (MCI) subtypes via cluster analysis within the Alzheimer's Disease Neuroimaging Initiative (ADNI) and demonstrated high correspondence between patterns of cortical thinning at baseline and each cognitive subtype. We aimed to determine whether our MCI subtypes demonstrate unique longitudinal atrophy patterns. Methods ADNI participants (295 with MCI and 134 cognitively normal [CN]) underwent annual structural MRI and neuropsychological assessments. General linear modeling compared vertex-wise differences in cortical atrophy rates between each MCI subtype and the CN group. Linear mixed models examined trajectories of cortical atrophy over 3 years within lobar regions of interest. Results Compared to the CN group, those with amnestic MCI (memory deficit) initially demonstrated greater atrophy rates within medial temporal lobe regions that became more widespread over time. Those with dysnomic/amnestic MCI (naming/memory deficits) showed greater atrophy rates largely localized to temporal lobe regions. The mixed MCI (impairment in all cognitive domains) group showed greater atrophy rates in widespread regions at all time points. The cluster-derived normal group, who had intact neuropsychological performance and normal cortical thickness at baseline despite their MCI diagnosis via conventional diagnostic criteria, continued to show normal cognition and minimal cortical atrophy over 3 years. Conclusions ADNI's purported amnestic MCI sample produced more refined cognitive subtypes with unique longitudinal cortical atrophy rates. These novel MCI subtypes reliably reflect underlying atrophy, reduce false-positive diagnostic errors, and improve prediction of clinical course. Such improvements have implications for the selection of participants for clinical trials and for providing more precise risk assessment for individuals diagnosed with MCI.