Dementia is associated with medial temporal atrophy even after accounting for neuropathologies.
Dementia is associated with medial temporal atrophy even after accounting for neuropathologies.
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DOI：
10.1093/braincomms/fcac052
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发表时间：
2022
影响因子：
4.8
通讯作者：
Alzheimer's Disease Neuroimaging Initiative
中科院分区：
文献类型：
--
作者：
Woodworth DC;Sheikh-Bahaei N;Scambray KA;Phelan MJ;Perez-Rosendahl M;Corrada MM;Kawas CH;Sajjadi SA;Alzheimer's Disease Neuroimaging Initiative
脑萎缩与退行性神经病变和痴呆的临床状态有关。痴呆症是否与独立于神经病理学的萎缩有关尚不清楚。在这项研究中，我们检查了与痴呆相关的萎缩模式，同时考虑了最常见的痴呆相关神经病理学。我们使用了来自国家阿尔茨海默病协调中心（n = 129）和阿尔茨海默病神经影像学倡议（n = 47）的数据，这些参与者具有合适的体内3D-T1 w MRI和尸检数据。我们在最接近MRI的访视时确定痴呆状态。我们研究了以下二分的神经病理学变量：阿尔茨海默病神经病理学，海马硬化，路易体，脑淀粉样血管病和动脉粥样硬化。基于体素的形态测量学在考虑神经病理学后确定了与痴呆相关的区域。对确定的感兴趣区域进行了进一步分析。我们使用多元线性回归模型调整神经病理学和人口统计学变量。我们还检查了以痴呆和临床痴呆评分总和作为结果的模型，并探讨了内侧颞叶结构体积对病理和认知之间关系的潜在介导作用。我们发现痴呆与海马体、杏仁核和海马旁体的体积有很强的相关性（在国家阿尔茨海默病协调中心，所有区域的半偏相关性≥ 0.28，P < 0.0001;在阿尔茨海默病神经成像倡议中，海马体和海马旁体的半偏相关性≥ 0.35，P ≤ 0.01）。与神经病理学变量相比，痴呆状态在这些结构的萎缩中占更多的独特方差（10.8%）;唯一的例外是海马硬化，其在海马萎缩中占更多的方差（10%）。我们还发现，内侧颞叶结构的体积有助于解释独立于神经病理学的临床痴呆评分总和的方差（范围从5%到9%），并部分介导阿尔茨海默病神经病理学和认知之间的关联。即使在解释了最常见的神经病理学之后，痴呆症仍然与内侧颞叶结构萎缩有最强的关联。这表明内侧颞叶萎缩与痴呆的临床状态最相关，而不是阿尔茨海默病或其他神经病理学，海马硬化症可能除外。Woodworth等人报告称，MRI测量的内侧颞叶萎缩与痴呆症密切相关，即使在解释了尸检的脑部病理后也是如此。这表明在MRI上看到的萎缩反映了神经退行性变，并不完全由包括阿尔茨海默病在内的常见病理引起。
Brain atrophy is associated with degenerative neuropathologies and the clinical status of dementia. Whether dementia is associated with atrophy independent of neuropathologies is not known. In this study, we examined the pattern of atrophy associated with dementia while accounting for the most common dementia-related neuropathologies. We used data from National Alzheimer’s Coordinating Center (n = 129) and Alzheimer’s Disease Neuroimaging Initiative (n = 47) participants with suitable in vivo 3D-T1w MRI and autopsy data. We determined dementia status at the visit closest to MRI. We examined the following dichotomized neuropathological variables: Alzheimer’s disease neuropathology, hippocampal sclerosis, Lewy bodies, cerebral amyloid angiopathy and atherosclerosis. Voxel-based morphometry identified areas associated with dementia after accounting for neuropathologies. Identified regions of interest were further analysed. We used multiple linear regression models adjusted for neuropathologies and demographic variables. We also examined models with dementia and Clinical Dementia Rating sum of the boxes as the outcome and explored the potential mediating effect of medial temporal lobe structure volumes on the relationship between pathology and cognition. We found strong associations for dementia with volumes of the hippocampus, amygdala and parahippocampus (semi-partial correlations ≥ 0.28, P < 0.0001 for all regions in National Alzheimer’s Coordinating Center; semi-partial correlations ≥ 0.35, P ≤ 0.01 for hippocampus and parahippocampus in Alzheimer’s Disease Neuroimaging Initiative). Dementia status accounted for more unique variance in atrophy in these structures (∼8%) compared with neuropathological variables; the only exception was hippocampal sclerosis which accounted for more variance in hippocampal atrophy (10%). We also found that the volumes of the medial temporal lobe structures contributed towards explaining the variance in Clinical Dementia Rating sum of the boxes (ranging from 5% to 9%) independent of neuropathologies and partially mediated the association between Alzheimer’s disease neuropathology and cognition. Even after accounting for the most common neuropathologies, dementia still had among the strongest associations with atrophy of medial temporal lobe structures. This suggests that atrophy of the medial temporal lobe is most related to the clinical status of dementia rather than Alzheimer's disease or other neuropathologies, with the potential exception of hippocampal sclerosis. Woodworth et al. report that MRI-measured atrophy of the medial temporal lobe is strongly associated with dementia even after accounting for brain pathologies from an autopsy. This suggests atrophy seen on MRI is reflective of neurodegeneration not entirely accounted for by common pathologies including Alzheimer’s disease.
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