Abstract
Alzheimer's disease (AD) is associated with widespread structural and functional brain alterations. The current study examined the gray matter (GM) voxel based morphometric (VBM) correlates of cognitive and clinical severity scores in patients with AD. The study included 34 patients with AD according to NINCDS/ADRDA AD criteria and 28 matched elderly controls. All subjects were clinically evaluated using Hindi Mental Status Examination (HMSE), Everyday Abilities Scale for India (EASI) and the Clinical Dementia Rating (CDR) scale. The structural Magnetic Resonance Imaging (MRI) data were acquired using a 3 Tesla MRI scanner and VBM analysis was performed using VBM5.1 toolbox. The patients with AD had significantly lower GM volume, white matter volume and total brain volume as compared to controls. The HMSE scores were positively correlated (p=0.009) and EASI (p=0.04) & CDR (p=0.0004) were negatively correlated with the total GM volumes in patients with AD. The VBM analysis revealed diffuse GM atrophy in patients with AD. Frontal& temporal GM volumes were positively correlated with the HMSE scores. Thus the results of the study replicate the previous observations of generalized GM atrophy, in an Indian sample with AD. The cognitive decline, clinical dementia severity and impairment in activities of daily living were correlated whole brain GM and WM volumes as well as with specific brain regional atrophy in AD. However further studies with larger samples & with more detailed cognitive evaluation are required for confirmation & validation of the relationship between regional morphometric abnormalities and cognitive deficits in AD.
Highlights
Alzheimer’s dementia (AD) is associated with widespread structural and functional brain alterations
Thirty-four patients with probable Alzheimer’s disease (AD) according to NINCDS/ADRDA AD criteria [11] were prospectively recruited for the study from January 2009 to December 2010 from patients who attended the Geriatric Clinic at the National Institute of Mental Health And Neurosciences (NIMHANS), Bangalore, India
Hindi Mental Status Examination (HMSE) scores were positively correlated (p=0.009) while Everyday Abilities Scale for India (EASI) (p=0.04) and Clinical Dementia Rating (CDR) (p=0.0004) scores were negatively correlated with the total GM volume when all subjects were pooled together
Summary
Alzheimer’s dementia (AD) is associated with widespread structural and functional brain alterations. Voxel-based morphometry (VBM) is a method for examining brain morphometry using structural MRI. Some of the commonly used cognitive assessment tools in AD, like Alzheimer’s disease Assessment Scale-Cognitive subscale (ADASCog) and Mini mental status examination (MMSE) have shown that cognitive decline is related with regional GM degeneration in the left temporal lobe [9]. Studies that have linked cognitive deficits as assessed by regionally validated cognitive assessment tools with structural brain changes in AD are limited. The present study aimed at examining structural brain alterations in AD in comparison to matched healthy elderly using VBM analysis, a hypothesis-free voxel-based whole brain morphometric method. The study aimed at linking cognitive decline with structural brain alterations in these patients. Hindi Mental Status Examination (HMSE) [13] was used for assessment of overall cognitive abilities. The MRI data was acquired using Phillips Archieva 3 Tesla MRI Machine, according to the following scanning protocol: Orientation-sagittal; FOV-256 x 256 x 155 mm; voxel size- 1mm x 1mm x 1mm; slice thickness-1 mm; acquisition matrix-256 x 256; TR=8.1 ms; TE=3.7 ms; flip angle=8 degree; sense factor=3.5; total scan time= 7 min 41 sec with 165 sagittal slices
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