BackgroundIncreasing age is the biggest risk factor for dementia, of which Alzheimer’s disease is the commonest cause. The pathological changes underpinning Alzheimer’s disease are thought to develop at least a decade prior to the onset of symptoms. Molecular positron emission tomography and multi-modal magnetic resonance imaging allow key pathological processes underpinning cognitive impairment – including β-amyloid depostion, vascular disease, network breakdown and atrophy – to be assessed repeatedly and non-invasively. This enables potential determinants of dementia to be delineated earlier, and therefore opens a pre-symptomatic window where intervention may prevent the onset of cognitive symptoms.Methods/designThis paper outlines the clinical, cognitive and imaging protocol of “Insight 46”, a neuroscience sub-study of the MRC National Survey of Health and Development. This is one of the oldest British birth cohort studies and has followed 5362 individuals since their birth in England, Scotland and Wales during one week in March 1946. These individuals have been tracked in 24 waves of data collection incorporating a wide range of health and functional measures, including repeat measures of cognitive function. Now aged 71 years, a small fraction have overt dementia, but estimates suggest that ~1/3 of individuals in this age group may be in the preclinical stages of Alzheimer’s disease. Insight 46 is recruiting 500 study members selected at random from those who attended a clinical visit at 60–64 years and on whom relevant lifecourse data are available. We describe the sub-study design and protocol which involves a prospective two time-point (0, 24 month) data collection covering clinical, neuropsychological, β-amyloid positron emission tomography and magnetic resonance imaging, biomarker and genetic information. Data collection started in 2015 (age 69) and aims to be completed in 2019 (age 73).DiscussionThrough the integration of data on the socioeconomic environment and on physical, psychological and cognitive function from 0 to 69 years, coupled with genetics, structural and molecular imaging, and intensive cognitive and neurological phenotyping, Insight 46 aims to identify lifetime factors which influence brain health and cognitive ageing, with particular focus on Alzheimer’s disease and cerebrovascular disease. This will provide an evidence base for the rational design of disease-modifying trials.
ObjectiveTo summarise the incidental findings detected on brain imaging and blood tests during the first wave of data collection for the Insight 46 study.DesignProspective observational sub-study of a birth cohort.SettingSingle-day assessment at a research centre in London, UK.Participants502 individuals were recruited from the MRC National Survey of Health and Development (NSHD), the 1946 British birth cohort, based on pre-specified eligibility criteria; mean age was 70.7 (SD: 0.7) and 49% were female.Outcome measuresData regarding the number and types of incidental findings were summarised as counts and percentages, and 95% confidence intervals were calculated.Results93.8% of participants completed a brain scan (n=471); 4.5% of scanned participants had a pre-defined reportable abnormality on brain MRI (n=21); suspected vascular malformations and suspected intracranial mass lesions were present in 1.9% (n=9) and 1.5% (n=7) respectively; suspected cerebral aneurysms were the single most common vascular abnormality, affecting 1.1% of participants (n=5), and suspected meningiomas were the most common intracranial lesion, affecting 0.6% of participants (n=3); 34.6% of participants had at least one abnormality on clinical blood tests (n=169), but few reached the prespecified threshold for urgent action (n=11).ConclusionsIn older adults, aged 69-71 years, potentially serious brain MRI findings were detected in around 5% of participants, and clinical blood test abnormalities were present in around one third of participants. Knowledge of the expected prevalence of incidental findings in the general population at this age is useful in both research and clinical settings.
International audienceA new development of the TomoRebuild software package is presented, including “thick sample” correction for non linear X-ray production (NLXP) and X-ray absorption (XA). As in the previous versions, C++ programming with standard libraries was used for easier portability. Data reduction requires different steps which may be run either from a command line instruction or via a user friendly interface, developed as a portable Java plugin in ImageJ. All experimental and reconstruction parameters can be easily modified, either directly in the ASCII parameter files or via the ImageJ interface. A detailed user guide in English is provided. Sinograms and final reconstructed images are generated in usual binary formats that can be read by most public domain graphic softwares. New MLEM and OSEM methods are proposed, using optimized methods from the NiftyRec medical imaging library. An overview of the different medical imaging methods that have been used for ion beam microtomography applications is presented. In TomoRebuild, PIXET data reduction is performed for each chemical element independently and separately from STIMT, except for two steps where the fusion of STIMT and PIXET data is required: the calculation of the correction matrix and the normalization of PIXET data to obtain mass fraction distributions. Correction matrices for NLXP and XA are calculated using procedures extracted from the DISRA code, taking into account a large X-ray detection solid angle. For this, the 3D STIMT mass density distribution is used, considering a homogeneous global composition. A first example of PIXET experiment using two detectors is presented. Reconstruction results are compared and found in good agreement between different codes: FBP, NiftyRec MLEM and OSEM of the TomoRebuild software package, the original DISRA, its accelerated version provided in JPIXET and the accelerated MLEM version of JPIXET, with or without correction
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