Imagerie cérébrale du vieillissement normal : contraste avec la maladie d’Alzheimer

Abstract

With age, the brain undergoes both structural and functional alterations. Overall, the literature consistently reports global brain atrophy in normal adults, generally more pronounced in frontal areas. As a result of different methodologies and inclusion criteria, other brain areas have been the matter of conflicting findings, notably the hippocampus. Regarding resting-state PET studies, they have consistently highlighted a metabolic deterioration of the frontal and anterior cingulated cortices. By contrast, relatively few investigations have sought to identify those areas that remain intact with aging, or undergo the least deterioration. We report a study designed to establish a comprehensive profile of both structural and functional changes in the aging brain, using up-to-date voxel-based methodology in 45 optimally healthy subjects aged 20-83 years. One of the main findings is that the lesser structural deterioration of the anterior hippocampal region, together with the lesser functional alteration of the posterior cingulate cortex, appear to mark the parting of the ways between normal aging and Alzheimer's disease, which is characterized by early and prominent deterioration of both structures. This paper also deals with studies set out to establish the relationship between changes in episodic memory retrieval in normal aging on the one hand and gray matter volume and 18FDG uptake on the other hand. Frontal areas dysfunction is involved in memory decline in older subjects, at least in some conditions, a finding which clearly contrasts with that found in Alzheimer's disease where the hippocampus plays a key role. Finally, compensatory mechanisms are reviewed through activation studies which often show supplementary activations in old subjects compared to young as well as in Alzheimer's disease patients compared to healthy elderly subjects. Paradoxically, those mechanisms seem to be underpinned, at least partially, by frontal areas in both populations, but researches are needed to better identify which subregions are involved.