Brain Advance Access originally published online on May 28, 2007
Brain 2007 130(7):1777-1786; doi:10.1093/brain/awm112
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3D maps from multiple MRI illustrate changing atrophy patterns as subjects progress from mild cognitive impairment to Alzheimer's disease
Departments of 1Radiology, 2Biostatistics and 3Neurology (Behavioral Neurology), Mayo Clinic Rochester, MN, USA
Correspondence to: Clifford R. Jack Jr, MD, Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA E-mail: jack.clifford{at}mayo.edu
Mild cognitive impairment (MCI), particularly the amnestic subtype (aMCI), is considered as a transitional stage between normal aging and a diagnosis of clinically probable Alzheimer's disease (AD). The aMCI construct is particularly useful as it provides an opportunity to assess a clinical stage which in most subjects represents prodromal AD. The aim of this study was to assess the progression of cerebral atrophy over multiple serial MRI during the period from aMCI to progression to AD. Thirty-three subjects were selected that fulfilled clinical criteria for aMCI and had three serial MRI scans: the first scan 
3 years before the diagnosis of AD, the second scan 1 year before, and the third scan at the time of the diagnosis of AD. A group of 33 healthy controls were age and gender-matched to the study cohort. Voxel-based morphometry (VBM) was used to assess patterns of grey matter atrophy in the aMCI subjects at each time-point compared to the control group. Customized templates and prior probability maps were used to avoid normalization and segmentation bias. The pattern of grey matter loss in the aMCI subject scans that were 3 years before the diagnosis of AD was focused primarily on the medial temporal lobes, including the amygdala, anterior hippocampus and entorhinal cortex, with some additional involvement of the fusiform gyrus, compared to controls. The extent and magnitude of the cerebral atrophy further progressed by the time the subjects were 1 year before the diagnosis of AD. At this point atrophy in the temporal lobes spread to include the middle temporal gyrus, and extended into more posterior regions of the temporal lobe to include the entire extent of the hippocampus. The parietal lobe also started to become involved. By the time the subjects had progressed to a clinical diagnosis of AD the pattern of grey matter atrophy had become still more widespread with more severe involvement of the medial temporal lobes and the temporoparietal association cortices and, for the first time, substantial involvement of the frontal lobes. This pattern of progression fits well with the Braak and Braak neurofibrillary pathological staging scheme in AD. It suggests that the earliest changes occur in the anterior medial temporal lobe and fusiform gyrus, and that these changes occur at least 3 years before progression to the diagnosis of AD. These results also suggest that 3D patterns of grey matter atrophy may help to predict the time to the first diagnosis of AD in subjects with aMCI.
Key Words: Alzheimer's disease; mild cognitive impairment; longitudinal; magnetic resonance imaging; voxel-based morphometry
Abbreviations: CDR, Clinical Dementia Rating; DRS, Dementia Rating Scale; MCI, mild cognitive impairment; MMSE, Mini-Mental Status Examination
Received March 16, 2007. Revised April 11, 2007. Accepted April 19, 2007.
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