Dynamics of brain structure and cognitive function in the Alzheimer's disease neuroimaging initiative
- Xiaowei Song1,2,
- Arnold Mitnitski2,3,
- Ningnannan Zhang1,4,
- Wei Chen1,4,
- Kenneth Rockwood2,5,
- for the Alzheimer's Disease Neuroimaging Initiative
- 1Biodiagnostics Atlantic, National Research Council Canada, Halifax, Canada
- 2Division of Geriatric Medicine, Dalhousie University, Halifax, Canada
- 3Department of Mathematics and Statistics, Dalhousie University, Halifax, Canada
- 4Department of Radiology, Tianjin Medical University, Tianjin, China
- 5Centre for Health Care of the Elderly, QEII Health Sciences Centre, Halifax, Canada
- Correspondence to Professor Kenneth Rockwood, Suite 1421, 5955 Veterans’ Memorial Lane, Halifax, Nova Scotia, Halifax B3H 2E1, Canada;
- Received 7 July 2012
- Revised 29 August 2012
- Accepted 20 September 2012
- Published Online First 2 November 2012
Background On average, cognition declines as people age, but improvement can also occur.
Objective To evaluate the dynamics of age-related changes in brain structure and cognitive function in patients with mild Alzheimer's disease (AD) and mild cognitive impairment (MCI) and in healthy control (HC) older adults.
Methods High-resolution 3-Tesla MRI and clinical data were obtained from the Alzheimer's Disease Neuroimaging Initiative in 187 subjects (a cohort aged 55–91 years; AD=43, MCI=84, HC=60). At 24 months, 151 people had clinical and 128 had MRI follow-up. Brain structure was assessed using the Medial Temporal Atrophy Scale (MTAS) and the Brain Atrophy and Lesion Index (BALI). Cognition was assessed using the Mini-Mental State Examination (MMSE) and the Alzheimer Disease Assessment Scale-cognitive subscale (ADAS-cog). Responsiveness was tested. Changes were analysed using a multistate dynamic model, adjusted for age, gender, ApoE4 genotype and vascular risk factors.
Results Over 2 years, decline in brain structure and cognition predominated, each showing detectable effect sizes (Cohen's d=0.33 for MTAS, 0.32 for BALI, 0.41 for MMSE, 0.38 for ADAS-cog; standard response mean=0.71, 0.69, 0.50 and 0.47, respectively). Structural improvement was observed (10.2% in BALI and 0.8% in MTAS), as was cognitive improvement (23.2% MMSE, 27.2% ADAS-cog). Most people (66.7%) whose BALI score improved also improved in either the MMSE or ADAS-cog. No patient with MCI whose MTAS or BALI improved converted to AD.
Conclusions Despite average decline in brain structure, improvement was observed and related to cognition and MCI–AD conversion. Ageing-related brain changes reflect a dynamic process.