Abstract
Cognitive assessments and neuroimaging are routinely combined in clinical practice to diagnose dementia represented by Alzheimer's disease (AD). The Montreal Cognitive Assessment (MoCA) is reported to be more suitable than the Mini-Mental State Examination (MMSE) for screening mild cognitive impairment (MCI) and mild AD. On the other hand, attention to the subfield volumes of the medial temporal lobe has recently been considered important for the differential diagnosis and early detection of AD. The aim of this study was to uncover which specific hippocampal subfields and adjacent extrahippocampal structures contribute to deficits in cognitive assessment scores in patients with MCI and AD. We recruited from our institute 31 Japanese patients—14 with amnestic MCI and 17 with probable AD, with a clinical dementia rating (CDR) of 0.5 and 1, respectively—and 50 healthy elderly individuals with a CDR of 0. All participants underwent magnetic resonance imaging and cognitive assessments with the MMSE, Wechsler Memory Scale-Revised Logical Memory I and II, and Japanese version of the MoCA (MoCA-J). With adjustment for age and sex, we performed partial correlation analysis of the cognitive assessment scores with the subfield volumes of the medial temporal lobe measured by software-mediated automatic segmentation of hippocampal subfields using high-resolution T1-and T2-weighted images. Compared with normal controls, patients with MCI and AD showed subfield volume reductions in cornu ammonis (CA) 1, CA2, Brodmann area (BA) 35, BA36, the dentate gyrus (DG), the subiculum, and the entorhinal cortex (ERC). All participants showed high correlation coefficients (above 0.6) between cognitive assessment scores and subfield volumes in CA1, the DG, the subiculum, the ERC, and BA36. In patients with MCI and AD, the MoCA-J showed higher correlations than the MMSE with subfield volumes in CA1, the DG, the subiculum, and the ERC. These results suggest that the combination of the in vivo analysis of subfield morphometry of the medial temporal lobe with the MoCA-J paradigm provides important insights into whether changes within specific subfields are related to the cognitive profile in MCI and AD.
Highlights
According to the World Health Organization, the proportion of the population over the age of 60 years is increasing year by year, with the total number of dementia patients projected to increase to 82 million in 2030 and to 152 million in 2050 [1]
In dementia represented by Alzheimer's disease (AD), early detection allows for rapid assessment and treatment of reversible or treatable causes [2]
We recruited from our institute 31 Japanese patients (19 women, 12 men)—14 with amnestic mild cognitive impairment (MCI) and 17 with probable AD, with a clinical dementia rating (CDR) [16, 17] of 0.5 and 1, respectively—and 50 healthy elderly participants (27 women, 23 men) with a CDR of 0
Summary
According to the World Health Organization, the proportion of the population over the age of 60 years is increasing year by year, with the total number of dementia patients projected to increase to 82 million in 2030 and to 152 million in 2050 [1]. In dementia represented by Alzheimer's disease (AD), early detection allows for rapid assessment and treatment of reversible or treatable causes [2]. Accurate and early diagnosis plays an important role in patient care and the development of future treatments [2, 3]. It is important to screen older persons with mild cognitive impairment (MCI), the prodromal stage of AD, and to provide them with an appropriate intervention. As a drawback, the MMSE has often been criticized for its poor screening sensitivity for mild dementia and MCI [5, 6]. The Montreal Cognitive Assessment (MoCA) was developed in Canada to screen patients falling within the normal range in the MMSE [7]. In Japan, Fujiwara et al [8] confirmed the reliability and validity of the Japanese
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