Abstract
Objective: To explore microstructural and cerebral blood flow (CBF) abnormalities in individuals with subjective cognitive decline plus (SCD plus) using diffusional kurtosis imaging (DKI) and three-dimensional (3D) arterial spin labeling (ASL).Methods: Twenty-seven patients with SCD plus, 31 patients with amnestic mild cognitive impairment (aMCI), and 33 elderly controls (ECs) were recruited and underwent DKI and 3D ASL using a GE 3.0-T MRI. Mean kurtosis (MK), fractional anisotropy (FA), mean diffusivity (MD), and CBF values were acquired from 24 regions of interest (ROIs) in the brain, including the bilateral hippocampal (Hip) subregions (head, body, and tail), posterior cingulate cortex (PCC), precuneus, dorsal thalamus subregions (anterior nucleus, ventrolateral nucleus, and medial nucleus), lenticular nucleus, caput nuclei caudati, white matter (WM) of the frontal lobe, and WM of the occipital lobe. Pearson's correlation analysis was performed to assess the relationships among the DKI-derived parameters, CBF values, and key neuropsychological tests for SCD plus.Results: Compared with ECs, participants with SCD plus showed a significant decline in MK and CBF values, mainly in the Hip head and PCC, and participants with aMCI exhibited more significant abnormalities in the MK and CBF values than individuals with ECs and SCD plus in multiple regions. Combined MK values showed better discrimination between patients with SCD plus and ECs than that obtained using CBF levels, with areas under the receiver operating characteristic (ROC) curve (AUC) of 0.874 and 0.837, respectively. Similarly, the AUC in discriminating SCD plus from aMCI patients obtained using combined MK values was 0.823, which was also higher than the combined AUC of 0.779 obtained using CBF values. Moreover, MK levels in the left Hip (h) and left PCC positively correlated with the auditory verbal learning test-delayed recall (AVLT-DR) score in participants with SCD plus. By contrast, only the CBF value in the left Hip head positively correlated with the AVLT-DR score.Conclusions: Our results provide new evidence of microstructural and CBF changes in patients with SCD plus. MK may be used as an early potential neuroimaging biomarker and may be a more sensitive DKI parameter than CBF at the very early stage of Alzheimer's disease (AD).
Highlights
Subjective cognitive decline (SCD), the first clinical manifestation in the Alzheimer’s disease (AD) continuum, refers to a selfexperienced cognitive capacity decline and has been shown to be associated with a high risk of conversion to AD (Tandetnik et al, 2015)
The SCD plus and amnestic MCI (aMCI) groups were recruited from the outpatient clinic, and ECs were recruited through a medical examination center
No significant differences were found with respect to age, sex, and education among participants with SCD plus, aMCI, and ECs
Summary
Subjective cognitive decline (SCD), the first clinical manifestation in the Alzheimer’s disease (AD) continuum, refers to a selfexperienced cognitive capacity decline and has been shown to be associated with a high risk of conversion to AD (Tandetnik et al, 2015). Previous studies have shown that SCD patients present with atrophy in the hippocampus (Hip), the paraHip, the medial temporal, and the frontoparietal gray matter (GM) (van der Flier et al, 2004; Saykin et al, 2006; Wen et al, 2019); alterations in the white matter (WM) (Song et al, 2016); decline of brain metabolism (Jeong et al, 2017); accumulation of high β-amyloid (Aβ) (Snitz et al, 2013); and disruption of functional activity (Sun et al, 2016) These results showed that SCD, MCI, and AD are regarded as a spectrum of clinical disorders (Kiuchi et al, 2014; Yan et al, 2018; Reisberg et al, 2020). Identifying neuroimaging biomarkers for SCD plus is essential for early detection, early intervention, and reduction of the burden of dementia in the population
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