Dataset Information

Association of Brain Magnetic Resonance Imaging Signs With Cognitive Outcomes in Persons With Nonimpaired Cognition and Mild Cognitive Impairment.

ABSTRACT:

Importance

Brain atrophy and vascular lesions contribute to dementia and mild cognitive impairment (MCI) in clinical referral populations. Prospective evidence in older general populations is limited.

Objective

To evaluate which magnetic resonance imaging (MRI) signs are independent risk factors for dementia and MCI.

Design, setting, and participants

This population-based cohort study included 1553 participants sampled from the Atherosclerosis Risk in Communities Study who had brain MRI scans and were dementia free during visit 5 (June 2011 to September 2013). Participants' cognitive status was evaluated through visit 6 (June 2016 to December 2017).

Exposures

Brain regional volumes, microhemorrhages, white matter hyperintensity (WMH) volumes, and infarcts measured on 3-T MRI.

Main outcomes and measures

Cognitive status (dementia, MCI, or nonimpaired cognition) was determined from in-person evaluations. Dementia among participants who missed visit 6 was identified via dementia surveillance and hospital discharge or death certificate codes. Cox proportional hazards models were used to evaluate the risk of dementia in 3 populations: dementia-free participants (N?=?1553), participants with nonimpaired cognition (n?=?1014), and participants with MCI (n?=?539). Complementary log-log models were used for risk of MCI among participants with nonimpaired cognition who also attended visit 6 (n?=?767). Models were adjusted for demographic variables, apolipoprotein E ?4 alleles, vascular risk factors, depressive symptoms, and heart failure.

Results

Overall, 212 incident dementia cases were identified among 1553 participants (mean [SD] age at visit 5, 76 [5.2] years; 946 [60.9%] women; 436 [28.1%] African American) with a median (interquartile range) follow-up period of 4.9 (4.3-5.2) years. Significant risk factors of dementia included lower volumes in the Alzheimer disease (AD) signature region, including hippocampus, entorhinal cortex, and surrounding structures (hazard ratio [HR] per 1-SD decrease, 2.40; 95% CI, 1.89-3.04), lobar microhemorrhages (HR, 1.90; 95% CI, 1.30-2.77), higher volumes of WMH (HR per 1-SD increase, 1.44; 95% CI, 1.23-1.69), and lacunar infarcts (HR, 1.66; 95% CI, 1.20-2.31). The AD signature region volume was also consistently associated with both MCI and progression from MCI to dementia, while subcortical microhemorrhages and infarcts contributed less to the progression from MCI to dementia.

Conclusions and relevance

In this study, lower AD signature region volumes, brain microhemorrhages, higher WMH volumes, and infarcts were risk factors associated with dementia in older community-based residents. Vascular changes were more important in the development of MCI than in its progression to dementia, while AD-related signs were important in both stages.

SUBMITTER: Wu A

PROVIDER: S-EPMC6512274 | biostudies-literature | 2019 May

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Association of Brain Magnetic Resonance Imaging Signs With Cognitive Outcomes in Persons With Nonimpaired Cognition and Mild Cognitive Impairment.

Wu Aozhou A Sharrett A Richey AR Gottesman Rebecca F RF Power Melinda C MC Mosley Thomas H TH Jack Clifford R CR Knopman David S DS Windham B Gwen BG Gross Alden L AL Coresh Josef J

JAMA network open 20190503 5

<h4>Importance</h4>Brain atrophy and vascular lesions contribute to dementia and mild cognitive impairment (MCI) in clinical referral populations. Prospective evidence in older general populations is limited.<h4>Objective</h4>To evaluate which magnetic resonance imaging (MRI) signs are independent risk factors for dementia and MCI.<h4>Design, setting, and participants</h4>This population-based cohort study included 1553 participants sampled from the Atherosclerosis Risk in Communities Study who ...[more]

PMID: 31074810

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Project description:Several magnetic resonance imaging studies have shown that the entorhinal cortex (ERC) is the first brain area related to pathologic changes in Alzheimer's disease (AD), even before atrophy of the hippocampus (HP). However, change in ERC morphology (thickness, surface area and volume) in the progression from aMCI to AD, especially in the subtypes of aMCI (single-domain and multiple-domain: aMCI-s and aMCI-m), however, is still unclear. ERC thickness, surface area and volume were measured in 29 people with aMCI-s, 22 people with aMCI-m, 18 patients with AD and 26 age-/sex-matched healthy controls. Group comparisons of the ERC geometry measurements (including thickness, volume and surface area) were performed using analyses of covariance (ANCOVA). Furthermore, receiver operator characteristic (ROC) analyses and the area under the curve (AUC) were employed to investigate classification ability (HC, aMCI-s, aMCI-m and AD from each other). There was a significant decreasing tendency in ERC thickness from HC to aMCI-s to aMCI-m to finally AD in both the left and the right hemispheres (left hemisphere: HC > aMCI-s > AD; right hemisphere: aMCI-s > aMCI-m > AD). For ERC volume, both the AD group and the aMCI-m group showed significantly decreased volume on both sides compared with the HC group. In addition, the AD group also had significantly decreased volume on both sides compared with the aMCI-s group. As for the ERC surface area, no significant difference was identified among the four groups. Furthermore, the AUC results demonstrate that combined ERC parameters (thickness and volume) can better discriminate the four groups from each other than ERC thickness alone. Finally, and most importantly, relative to HP volume, the capacity of combined ERC parameters was better at discriminating between HC and aMCI-s, as well as aMCI-m and AD. ERC atrophy, particularly the combination of ERC thickness and volume, might be regarded as a promising candidate biomarker in the diagnosis and differential diagnosis of aMCI and AD.

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Dataset Information

Association of Brain Magnetic Resonance Imaging Signs With Cognitive Outcomes in Persons With Nonimpaired Cognition and Mild Cognitive Impairment.

Importance

Objective

Design, setting, and participants

Exposures

Main outcomes and measures

Results

Conclusions and relevance

Publications

Association of Brain Magnetic Resonance Imaging Signs With Cognitive Outcomes in Persons With Nonimpaired Cognition and Mild Cognitive Impairment.

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