Abstract
ObjectiveTo determine whether lower cerebral blood flow (CBF) is associated with faster cognitive decline in patients with Alzheimer’s disease (AD).MethodsWe included 88 patients with dementia due to AD from the Amsterdam Dementia Cohort. Mean follow-up was 2 ± 1 years. Linear mixed models were used to determine associations of lower whole brain and regional pseudo-continuous arterial spin labelling measured CBF with rate of cognitive decline as measured with repeated mini-mental state examination (MMSE). Model 1 was adjusted for age, sex, and education. Model 2 was additionally adjusted for normalized gray matter volume, medial temporal lobe atrophy, white matter hyperintensities, microbleeds, and lacunes. Analyses were repeated after partial volume correction (PVC) of CBF. Statistical significance was set at p ≤ 0.05.ResultsPatients were 65 ± 7 years old, 44 (50 %) were women, and mean baseline MMSE was 22 ± 4. Annual decline (β[SE]) on the MMSE was estimated at -2.11 (0.25) points per year. Lower whole brain (β[SE]-0.50[0.25]; p ≤ 0.05) and parietal (β[SE]-0.59[0.25]; p < 0.05) CBF were associated with faster cognitive decline. PVC cortical CBF was not associated with cognitive decline.ConclusionsLower CBF, in particular in the posterior brain regions, may have value as a prognostic marker for rate of cognitive decline in AD.Key points• In AD, lower CBF is associated with more rapid cognitive decline.• Decreasing CBF does not reach a plateau early in AD.• PcASL-CFB has additive value to conventional structural MRI measures in AD.
Highlights
Alzheimer’s disease (AD) is a progressive neurodegenerative disorder and one of the aspects that determines progression is cognitive decline
In AD, lower Cerebral blood flow (CBF) is associated with more rapid cognitive decline
CBF can be measured with arterial spin labelling (ASL) and is found to be lower in AD patients compared to controls [7,8,9]
Summary
Alzheimer’s disease (AD) is a progressive neurodegenerative disorder and one of the aspects that determines progression is cognitive decline. In AD, cognitive decline appears to be largely variable between individual patients [1, 2] and predictors of. Eur Radiol (2017) 27:1169–1175 cognitive decline in patients with dementia due to AD are currently largely lacking [3]. Factors that predict decline in early phases of the disease, may lack prognostic value once patients are diagnosed with dementia [6]. Synaptic dysfunction continues throughout the course of AD [13] and is still associated with cognitive decline in later stages of AD [14]. Lower ASL-CBF has been found to predict conversion from mild cognitive impairment (MCI) to AD [15]. A lower ASL-CBF has been associated with worse cognition, even in the stage of AD dementia [8]. Using singlephoton emission computed tomography (SPECT), fast declining AD patients appeared to have a lower baseline CBF than more slowly declining patients [16, 17]
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