The Influence of White Matter Lesion Volume on Hippocampal Shape in Patients Along the Alzheimer’s Disease Continuum

Abstract

AbstractBackgroundAlzheimer’s Disease (AD) is a progressive neurocognitive disorder with irreversible hippocampal atrophy and degradation of cognitive function. Hippocampal atrophy can be assessed by volume and shape changes on MRI, and hippocampal volume is a sensitive marker for AD diagnosis and progression; however, it does not reflect regional changes within the hippocampus. Interest in shape analysis of the hippocampus is growing, as it provides more detailed assessment of morphological changes that highlight regional atrophic differences. Cerebral small vessel disease (CSVD) burden quantified as white matter lesion volume from MRI is strongly associated with hippocampal volume loss in AD and mild cognitive impairment (MCI). Our goal was to examine relationships between hippocampal morphometric features and white matter hyperintensity (WMH) volume, a measure of CSVD burden, across the AD continuum.MethodWe analyzed baseline data from 186 participants from the Wake Forest Alzheimer’s Disease Research Center (ADRC) Clinical Core cohort whose cognitive diagnosis was adjudicated by an expert panel in accordance with NIA‐AA guidelines (without reference to AD biomarkers). Participants ranged from cognitively normal (CN) (n = 62, 72±8y), to MCI (n = 62, 73±7y), and dementia (n = 62, 73±9y). We focused on the left hippocampus and used T1‐weighted images from 3T brain MRI to generate left hippocampal segmentations and total intracranial volume estimates. Total WMH volume was estimated from FLAIR images using the lesion segmentation toolbox for SPM, it was then normalized to intracranial volume and log transformed to address skewness. Hippocampal shape analysis was performed using SlicerSALT, and a multivariate linear model was implemented to relate WMH volume to hippocampal shape features while adjusting for diagnosis, age, sex, and years of education.ResultOn the superior aspect of the hippocampus, greater WMH volume was associated with more surface contraction of the anterior portions of the CA1, CA2, CA3 and subiculum as shown in Figure 1A. Similar effects were seen on the inferior aspect as shown in Figure 1B.ConclusionThese finding suggest that higher WMH volume is associated with selective hippocampal subfield degeneration in the anterior portions of the hippocampus which may be more vulnerable to CSVD buildup.