Individual subject classification of mixed dementia from pure subcortical vascular dementia based on subcortical shape analysis

PLoS One. 2013 Oct 10;8(10):e75602. doi: 10.1371/journal.pone.0075602. eCollection 2013.

Abstract

Subcortical vascular dementia (SVaD), one of common causes of dementia, has concomitant Alzheimer's disease (AD) pathology in over 30%, termed "mixed dementia". Identifying mixed dementia from SVaD is important because potential amyloid-targeted therapies may be effective for treatment in mixed dementia. The purpose of this study was to discriminate mixed dementia from pure SVaD using magnetic resonance imaging (MRI). We measured brain amyloid deposition using the 11C-Pittsburgh compound B positron emission tomography (PiB-PET) in 68 patients with SVaD. A PiB retention ratio greater than 1.5 was considered PiB(+). Hippocampal and amygdalar shape were used in the incremental learning method to discriminate mixed dementia from pure SVaD because these structures are known to be prominently involved by AD pathologies. Among 68 patients, 23 (33.8%) patients were positive for PiB binding. With use of hippocampal shape analysis alone, PiB(+) SVaD could be discriminated from PiB(-) SVaD with 77.9% accuracy (95.7% sensitivity and 68.9% specificity). With use of amygdalar shape, the discrimination accuracy was 75.0% (87.0% sensitivity and 68.9% specificity). When hippocampal and amygdalar shape were analyzed together, accuracy increased to 82.4% (95.7% sensitivity and 75.6% specificity). An incremental learning method using hippocampal and amygdalar shape distinguishes mixed dementia from pure SVaD. Furthermore, our results suggest that amyloid pathology and vascular pathology have different effects on the shape of the hippocampus and amygdala.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Amygdala / pathology
  • Dementia / classification
  • Dementia / pathology*
  • Dementia, Vascular / classification
  • Dementia, Vascular / pathology*
  • Female
  • Hippocampus / pathology
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Positron-Emission Tomography

Grants and funding

This study was supported by a grant from the Korea Healthcare Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (No. A102065, A120798), a Samsung Medical Center Clinical Research Development Program grant (CRL-108011 and CRS 110-14-1), the Converging Research Center Program through the Ministry of Education, Science and Technology (2010K001054), the National Research Foundation of Korea (NRF) grant funded by the Korea government (MEST) (No. 2013-00009999), the NRF grant funded by the Korea government (MSIP) (No. 2010-0028631), and Basic Science Research Program through the NRF funded by the Ministry of Education (No. 2012-004157). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.