Global gray matter changes in posterior cortical atrophy: a serial imaging study.

Manja Lehmann,Josephine Barnes,Nick C Fox,Sebastian J Crutch,Natalie S Ryan,Elizabeth K Warrington,Gerard R Ridgway

doi:10.1016/j.jalz.2011.09.225

Manja Lehmann, Josephine Barnes + Show 5 more

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https://doi.org/10.1016/j.jalz.2011.09.225

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Abstract

BackgroundPosterior cortical atrophy (PCA) is a neurodegenerative condition predominantly associated with Alzheimer’s disease (AD) pathology. Cross-sectional imaging studies have shown different atrophy patterns in PCA patients compared with typical amnestic Alzheimer’s disease (tAD) patients, with greatest atrophy commonly found in posterior regions in the PCA group, whereas in the tAD group, atrophy is most prominent in medial temporal lobe regions. However, differential longitudinal atrophy patterns are not well understood.MethodsThis study assessed longitudinal changes in brain and gray matter volumes in 17 PCA patients, 16 tAD patients, and 18 healthy control subjects. Both patient groups had symptom durations of approximately 5 years.ResultsProgressive gray matter losses in both PCA and tAD patients were relatively widespread throughout the cortex, compared with control subjects, and were not confined to areas related to initial symptomatology. A multivariate classification analysis revealed a statistically significant group separation between PCA and tAD patients, with 72.7% accuracy (P < .01).ConclusionProgression from an initially focal presentation to a more global pattern suggests that these different clinical presentations of AD might converge pathologically over time.

Highlights

Alzheimer’s disease (AD) is the most common cause of dementia in people aged .65 years [1], and it is estimated to affect 81 million people worldwide by 2040 [2]
There was a significant difference in baseline and follow-up Mini-Mental State Examination (MMSE) between posterior cortical atrophy (PCA) and control groups (P, .0001), and between typical amnestic Alzheimer’s disease (tAD) and control groups (P,.0001); no significant difference was found between PCA and tAD groups (P 5 .2 at baseline, P 5.3 at follow-up)
This study investigated the progression of atrophy in PCA patients compared with tAD patients and healthy control subjects

Summary

Introduction

Alzheimer’s disease (AD) is the most common cause of dementia in people aged .65 years [1], and it is estimated to affect 81 million people worldwide by 2040 [2]. It is typically characterized by an insidious onset of memory impairment that progresses to involve multiple cognitive domains [3]. This amnestic presentation is in accordance with histopathological and structural imaging studies showing early medial temporal lobe involvement. A smaller proportion of PCA cases may be underpinned by other conditions such as dementia with Lewy bodies, corticobasal degeneration, or, rarely, Creutzfeldt–Jakob disease [12,13]

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