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. 2015 Feb 7:7:456-62.
doi: 10.1016/j.nicl.2015.01.017. eCollection 2015.

Longitudinal assessment of global and regional atrophy rates in Alzheimer's disease and dementia with Lewy bodies

Elijah Mak  1 , Li Su  1 , Guy B Williams  2 , Rosie Watson  3 , Michael Firbank  4 , Andrew M Blamire  5 , John T O'Brien  1
Affiliations

Longitudinal assessment of global and regional atrophy rates in Alzheimer's disease and dementia with Lewy bodies

Elijah Mak et al. Neuroimage Clin. .

Abstract

Background & objective: Percent whole brain volume change (PBVC) measured from serial MRI scans is widely accepted as a sensitive marker of disease progression in Alzheimer's disease (AD). However, the utility of PBVC in the differential diagnosis of dementia remains to be established. We compared PBVC in AD and dementia with Lewy bodies (DLB), and investigated associations with clinical measures.

Methods: 72 participants (14 DLBs, 25 ADs, and 33 healthy controls (HCs)) underwent clinical assessment and 3 Tesla T1-weighted MRI at baseline and repeated at 12 months. We used FSL-SIENA to estimate PBVC for each subject. Voxelwise analyses and ANCOVA compared PBVC between DLB and AD, while correlational tests examined associations of PBVC with clinical measures.

Results: AD had significantly greater atrophy over 1 year (1.8%) compared to DLB (1.0%; p = 0.01) and HC (0.9%; p < 0.01) in widespread regions of the brain including periventricular areas. PBVC was not significantly different between DLB and HC (p = 0.95). There were no differences in cognitive decline between DLB and AD. In the combined dementia group (AD and DLB), younger age was associated with higher atrophy rates (r = 0.49, p < 0.01).

Conclusions: AD showed a faster rate of global brain atrophy compared to DLB, which had similar rates of atrophy to HC. Among dementia subjects, younger age was associated with accelerated atrophy, reflecting more aggressive disease in younger people. PBVC could aid in differentiating between DLB and AD, however its utility as an outcome marker in DLB is limited.

Keywords: Alzheimer's disease; Atrophy; Dementia; Lewy bodies; Neuroimaging.

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Figures

Fig. 1
Fig. 1
Box-and-whisker plots showing rates of whole brain atrophy for all diagnostic groups. Negative rates represent a decrease in whole brain volume over time. The horizontal lines in the boxes represent the 25th, 50th (median) and 75th percentiles of the distributions. The vertical lines extending from the boxes stop at the most extreme data points within 1.5 interquartile ranges of the boxes. Differences between groups were assessed by using ANCOVA controlling for age, gender and inter-scan interval, with post-hoc Tukey–Kramer tests. * = p < 0.05, ** = p < 0.01. Abbreviations: ANCOVA, analysis of covariance; DLB, dementia with Lewy bodies; AD, Alzheimer's disease; HC, healthy control.
Fig. 2
Fig. 2
Longitudinal voxelwise results. Areas of significant differences in atrophy rates between (A) AD and HC, (B) AD and DLB, and (C) correlation between atrophy rate and age in combined dementia group overlaid on the MNI152 standard template. Blue represents all the standard space brain edge voxels used for testing group differences in atrophy rates and associations with clinical measures. Red and yellow represent significant voxels, i.e. p values, FWE corrected. Abbreviations: DLB, dementia with Lewy bodies; AD, Alzheimer's disease; HC, healthy control; FWE, family wise error.
Fig. 3
Fig. 3
Scatterplots of age at baseline by whole-brain atrophy rate.
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