Mild cognitive impairment: differential atrophy in the hippocampal subfields

Abstract

Background and purpose: Hippocampus volumetry is a useful surrogate marker for the diagnosis of Alzheimer disease, but it seems insufficiently sensitive for the aMCI stage. We postulated that some hippocampus subfields are specifically atrophic in aMCI and that measuring hippocampus subfield volumes will improve sensitivity of MR imaging to detect aMCI.

Materials and methods: We evaluated episodic memory and hippocampus subfield volume in 15 patients with aMCI and 15 matched controls. After segmentation of the whole hippocampus from clinical MR imaging, we applied a new computational method allowing fully automated segmentation of the hippocampus subfields. This method used a Bayesian modeling approach to infer segmentations from the imaging data.

Results: In comparison with controls, subiculum and CA2-3 were significantly atrophic in patients with aMCI, whereas total hippocampus volume and other subfields were not. Total hippocampus volume in controls was age-related, whereas episodic memory was the main explanatory variable for both the total hippocampus volume and the subfields that were atrophic in patients with aMCI. Segmenting subfields increases sensitivity to diagnose aMCI from 40% to 73%.

Conclusions: Measuring CA2-3 and subiculum volumes allows a better detection of aMCI.

Fig 1.

Volumetric data of EC (n =15) and patients with aMCI (n =15). Error bars represent SEM =SD/√n. *, Significant F-test (P < .050) given below the corresponding structure. (*), Trend toward a significant difference (P < .100). Age and sex are introduced as covariates in the model.

Fig 2.

Coronal and axial views of the right hippocampus. Left images are from a control; right images are from a patient with aMCI. The use of a huge zoom on a standard clinical MR imaging explains the low resolution.