Brain atrophy rates predict subsequent clinical conversion in normal elderly and amnestic MCI
Brain atrophy rates predict subsequent clinical conversion in normal elderly and amnestic MCI
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DOI：
10.1212/01.wnl.0000180958.22678.91
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发表时间：
2005-10-25
期刊：
影响因子：
9.9
通讯作者：
Petersen, RC
中科院分区：
文献类型：
--
作者：
Jack, CR;Shiung, MM;Petersen, RC
目的：检验以下假设：在认知健康的老年受试者和具有柔滑的轻度认知障碍（MCI）的受试者中，从序列MRI研究中测得的临床MRI研究与随后临床转化为更受损状态有关的时间有关。方法：从阿尔茨海默氏病研究中心和阿尔茨海默氏病患者登记处发现了符合纳入标准的91名健康老年患者和72例符合纳入标准的羊膜MCI患者。从一对MRI研究中测量了1至2年的四个不同大脑结构 - 脑结构，内嗅皮层，整个大脑和心室的萎缩率。第二次扫描的时间标志着临床观察期的开始。结果：在随访期间，13名健康患者转化为MCI或阿尔茨海默氏病（AD），而39名MCI受试者转化为AD。在基线健康的人中，只有较大的心室年度体积变化（APC）与较高的转化率风险有关（1-SD增加1.9，p = 0.03）。在MCI受试者中，较大的心室体积APC（1-SD的危险比增加1.7，P <0.001）和更大的整个脑APC（1-SD增加1.4，p = 0.007）增加了转化为转换为广告。心室APC（1-SD的危险比增加1.59，p = 0.001）和整个脑APC（1-SD增加1.32，p = 0.009的危险比）为协变量调整后的横截面海马体积提供了其他预测信息在基线时，关于从MCI转换为AD的风险。讨论：较高的整个大脑和心室萎缩率在基线前1到2年与conversion依的危害增加有关。将基线时海马体积的量度与串行MRI扫描的整个大脑或心室萎缩率的度量相结合，提供了有关随后从轻度认知障碍到阿尔茨海默氏病的危险的免费预测信息。但是，与那些没有转换的人相比，重叠的人表明，这些措施不太可能为个别患者提供绝对的预后信息。
Objective: To test the hypothesis that the atrophy rate measured from serial MRI studies is associated with time to subsequent clinical conversion to a more impaired state in both cognitively healthy elderly subjects and in subjects with amnestic mild cognitive impairment (MCI). Methods: Ninety-one healthy elderly patients and 72 patients with amnestic MCI who met inclusion criteria were identified from the Mayo Alzheimer's Disease Research Center and Alzheimer's Disease Patient Registry. Atrophy rates of four different brain structures-hippocampus, entorhinal cortex, whole brain, and ventricle-were measured from a pair of MRI studies separated by 1 to 2 years. The time of the second scan marked the beginning of the clinical observation period. Results: During follow-up, 13 healthy patients converted to MCI or Alzheimer disease (AD), whereas 39 MCI subjects converted to AD. Among those healthy at baseline, only larger ventricular annual percent volume change (APC) was associated with a higher risk of conversion (hazard ratio for a 1-SD increase 1.9, p = 0.03). Among MCI subjects, both greater ventricular volume APC (hazard ratio for a 1-SD increase 1.7, p < 0.001) and greater whole brain APC (hazard ratio for a 1-SD increase 1.4, p = 0.007) increased the risk of conversion to AD. Both ventricular APC (hazard ratio for a 1-SD increase 1.59, p = 0.001) and whole brain APC (hazard ratio for a 1-SD increase 1.32, p = 0.009) provided additional predictive information to covariate-adjusted cross-sectional hippocampal volume at baseline about the risk of converting from MCI to AD. Discussion: Higher whole brain and ventricle atrophy rates 1 to 2 years before baseline are associated with an increased hazard of conversion to a more impaired state. Combining a measure of hippocampal volume at baseline with a measure of either whole brain or ventricle atrophy rates from serial MRI scans provides complimentary predictive information about the hazard of subsequent conversion from mild cognitive impairment to Alzheimer disease. However, overlap among those who did vs those who did not convert indicate that these measures are unlikely to provide absolute prognostic information for individual patients.