Abstract
Background: Previous studies suggest that brain atrophy can not only be defined by its morphological extent, but also by the cerebral blood flow (CBF) within a certain area of the brain, including white and gray matter. The aim of this study is to investigate known atrophy patterns in different forms of dementia and to compare segmented brain volumetrics and pulsed arterial spin labeling (pASL) data to explore the correlation between brain maps with atrophy and this non-contrast-enhanced brain-perfusion method. Methods: Our study comprised 17 patients with diagnosed cognitive impairment (five Alzheimer’s disease = AD, five frontotemporal dementia = FTD, seven mild cognitive impairment = MCI) and 19 healthy control subjects (CO). All patients and controls underwent 4D-pASL brain-perfusion MR imaging and T1w MPRAGE. The data were assessed regarding relative brain volume on the basis of 286 brain regions, and absolute and relative cerebral blood flow (CBF/rCBF) were derived from pASL data in the corresponding brain regions. Mini-Mental State Examination (MMSE) was performed to assess cognitive functions. Results: FTD patients demonstrated significant brain atrophy in 43 brain regions compared to CO. Patients with MCI showed significant brain atrophy in 18 brain regions compared to CO, whereas AD patients only showed six brain regions with significant brain atrophy compared to CO. There was good correlation of brain atrophy and pASL perfusion data in five brain regions of patients with diagnosed FTD, especially in the superior temporal gyrus (r = 0.900, p = 0.037), the inferior frontal white matter (pars orbitalis; r = 0.968, p = 0.007) and the thalami (r = 0.810, p = 0.015). Patients with MCI demonstrated a correlation in one brain region (left inferior fronto-occipital fasciculus; r = 0.786, p = 0.036), whereas patients with diagnosed AD revealed no correlation. Conclusions: pASL can detect affected brain regions in cognitive impairment and corresponds with brain atrophy, especially for patients suffering from FTD and MCI. However, there was no correlation of perfusion alterations and brain atrophy in AD. pASL perfusion might thus represent a promising tool for noninvasive brain-perfusion evaluation in specific dementia subtypes as a complimentary imaging-based bio marker in addition to brain volumetry.
Highlights
Dementia is an overall definition of conditions and brain diseases causing a long-term and often steady decline in cognitive abilities and memory, which are severe enough to impair daily life functioning, often including emotional, social and behavioral deficits.The understanding of the biological mechanisms for developing dementia in the human nervous system is as yet widely incomplete.There are a variety of biomarkers used for attempting to diagnose different forms of dementia and more sensitive monitoring of progression, even at an early stage of onset
We examined seventeen subjects with different forms of cognitive impairment and nineteen control subjects, which altogether were recruited from the University Hospital Erlangen, Bavaria, Germany
Patients diagnosed with frontotemporal dementia (FTD) demonstrated significant brain atrophy in 43 brain regions compared to the control subjects (CO) group
Summary
Dementia is an overall definition of conditions and brain diseases causing a long-term and often steady decline in cognitive abilities and memory, which are severe enough to impair daily life functioning, often including emotional, social and behavioral deficits. There are a variety of biomarkers used for attempting to diagnose different forms of dementia and more sensitive monitoring of progression, even at an early stage of onset. Alzheimer’s disease (AD)—the most common cause of dementia (~70%)—and frontotemporal dementia (FTD) are well-examined conditions. Reduced cerebral blood flow (CBF) seems to be associated with neurodegenerative progression due to reduced brain metabolism; it is not yet clear which one precedes the other. CBF could be a surrogate marker of brain function (neurovascular coupling) [3]
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