Regional atrophy is associated with impairment in distinct cognitive domains in Alzheimer's disease

Lieke L Smits; Betty M Tijms; Marije R Benedictus; Esther L G E Koedam; Teddy Koene; Ilona E W Reuling; Frederik Barkhof; Philip Scheltens; Yolande A L Pijnenburg; Mike P Wattjes; Wiesje M van der Flier

doi:10.1016/j.jalz.2013.06.007

Regional atrophy is associated with impairment in distinct cognitive domains in Alzheimer's disease

Alzheimers Dement. 2014 Oct;10(5 Suppl):S299-305. doi: 10.1016/j.jalz.2013.06.007. Epub 2013 Nov 6.

Affiliations

¹ Alzheimer Center and Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: [email protected].
² Alzheimer Center and Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands.
³ Alzheimer Center and Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands.
⁴ Alzheimer Center and Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands.
⁵ Alzheimer Center and Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands; Alzheimer Center and Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.

PMID: 24210526
DOI: 10.1016/j.jalz.2013.06.007

Abstract

Background: In Alzheimer's disease (AD), some patients present with cognitive impairment other than episodic memory disturbances. We evaluated whether occurrence of posterior atrophy (PA) and medial temporal lobe atrophy (MTA) could account for differences in cognitive domains affected.

Methods: In 329 patients with AD, we assessed five cognitive domains: memory, language, visuospatial functioning, executive functioning, and attention. Magnetic resonance imaging (MRI) was rated visually for the presence of MTA and PA. Two-way analyses of variance were performed with MTA and PA as independent variables, and cognitive domains as dependent variables. Gender, age, and education were covariates. As PA is often encountered in younger patients, analyses were repeated after stratification for age of onset (early onset, ≤65 years).

Results: The mean age of the participants was 67 years, 175 (53%) were female, and the mean Mini-Mental State Examination (score±standard deviation) was 20±5 points. Based on dichotomized magnetic resonance imaging ratings, 84 patients (26%) had MTA and PA, 98 (30%) had MTA, 57 (17%) had PA, and 90 (27%) had neither. MTA was associated with worse performance on memory, language, and attention (all, P<.05), and PA was associated with worse performance on visuospatial and executive functioning (both, P<.05). Stratification for age showed in patients with late-onset AD (n=173) associations between MTA and impairment on memory, language, visuospatial functioning, and attention (all, P<.05); in early-onset AD (n=156), patients with PA tended to perform worse on visuospatial functioning.

Conclusions: Regional atrophy is related to impairment in specific cognitive domains in AD. The prevalence of PA in a large set of patients with AD and its association with cognitive functioning provides support for the usefulness of this visual rating scale in the diagnostic evaluation of AD.

Keywords: Alzheimer's disease; Cognition; Magnetic resonance imaging; Neuropsychology; Visual rating scales.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Age of Onset
Aged
Aging / pathology
Aging / psychology
Alzheimer Disease / pathology*
Alzheimer Disease / physiopathology
Alzheimer Disease / psychology*
Atrophy
Attention
Brain / pathology*
Cognition Disorders / pathology
Cognition Disorders / physiopathology
Educational Status
Executive Function
Female
Humans
Language
Magnetic Resonance Imaging
Male
Memory
Mental Status Schedule
Neuropsychological Tests
Sex Characteristics
Space Perception