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Brain Advance Access originally published online on March 12, 2007
Brain 2007 130(4):1159-1166; doi:10.1093/brain/awm016
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© The Author (2007). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Different regional patterns of cortical thinning in Alzheimer's disease and frontotemporal dementia

An-Tao Du1,*, Norbert Schuff1,2, Joel H. Kramer3, Howard J. Rosen4, Maria Luisa Gorno-Tempini4, Katherine Rankin4, Bruce L. Miller4 and Michael W. Weiner1–5

1Center for Imaging of Neurodegenerative Diseases, Department of Veterans Affairs Medical Center, Departments of 2Radiology 3Psychiatry 4Neurology and 5Medicine, University of California, San Francisco, CA, USA

Correspondence to: An-Tao Du, MD, Center for Imaging of Neurodegenerative Diseases, VA Medical Center, 4150, Clement street, San Francisco, CA 94121, USA E-mail: antao.du{at}ucsf.edu

Alzheimer's disease and frontotemporal dementia (FTD) can be difficult to differentiate clinically because of overlapping symptoms. Distinguishing the two dementias based on volumetric measurements of brain atrophy with MRI has been only partially successful. Whether MRI measurements of cortical thinning improve the differentiation between Alzheimer's disease and FTD is unclear. In this study, we measured cortical thickness using a set of automated tools (Freesurfer) to reconstruct the brain's cortical surface from T1-weighted structural MRI data in 22 patients with Alzheimer's disease, 19 patients with FTD and 23 cognitively normal subjects. The goals were to detect the characteristic patterns of cortical thinning in these two types of dementia, to test the relationship between cortical thickness and cognitive impairment, to determine if measurement of cortical thickness is better than that of cortical volume for differentiating between these dementias and normal ageing and improving the classification of Alzheimer's disease and FTD based on neuropsychological scores alone. Compared to cognitively normal subjects, Alzheimer's disease patients had a thinner cortex primarily in bilateral, frontal, parietal, temporal and occipital lobes (P < 0.001), while FTD patients had a thinner cortex in bilateral, frontal and temporal regions and some thinning in inferior parietal regions and the posterior cingulate (P < 0.001). Compared to FTD patients, Alzheimer's disease patients had a thinner cortex (P < 0.001) in parts of bilateral parietal and precuneus regions. Cognitive impairment was negatively correlated with cortical thickness of frontal, parietal and temporal lobes in Alzheimer's disease, while similar correlations were not significant in FTD. Measurement of cortical thickness was similar to that of cortical volume in differentiating between normal ageing, Alzheimer's disease and FTD. Furthermore, cortical thickness measurements significantly improved the classification between Alzheimer's disease and FTD based on neuropsychological scores alone, including the Mini-Mental State Examination and a modified version of the Trail-Making Test. In conclusion, the characteristic patterns of cortical thinning in Alzheimer's disease and FTD suggest that cortical thickness may be a useful surrogate marker for these types of dementia.

Key Words: Alzheimer's disease; frontotemporal dementia; cortical thickness; cortical volume

Abbreviations: FTD, frontotemporal dementia; CN, cognitively normal; MMSE, Mini-Mental State Examination; CDR, Clinical Dementia Rating scale; TMT, Trail-Making Test

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Received September 16, 2006. Revised December 5, 2006. Accepted January 17, 2007.

*Present address: Department of Neurology, Wayne State University, Detroit, MI, USA E-mail: antao{at}wayne.edu


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