Incidental findings on brain MRI of cognitively normal first-degree descendants of patients with Alzheimer's disease: a cross-sectional analysis from the ALFA (Alzheimer and Families) project

Abstract

ObjectivesTo describe the prevalence of brain MRI incidental findings (IF) in a cohort of cognitively normal first-degree descendants of patients with Alzheimer's disease (AD).DesignCross-sectional observational study.SettingAll scans were obtained with a 3.0 T scanner. Scans were evaluated by a single neuroradiologist and IF recorded and categorised. The presence of white matter hyperintensities (WMH) was determined with the Fazekas scale and reported as relevant if ≥2.Participants575 participants (45–75 years) underwent high-resolution structural brain MRI. Participants were cognitively normal and scored over the respective cut-off values in all the following neuropsychological tests: Mini-Mental State Examination (≥26), Memory Impairment Screen (≥6), Time Orientation Subtest of the Barcelona Test II (≥68), verbal semantic fluency (naming animals ≥12). Clinical Dementia Rating (CDR) had to be 0.Results155 participants (27.0%) presented with at least one IF. Relevant WMH were present in 7.8% of the participants, and vascular abnormalities, cyst and brain volume loss in 10.7%, 3.1% and 6.9% of the study volunteers, respectively. Neoplastic brain findings were found in 2.4% of participants and within these, meningiomas were the most common (1.7%) and more frequently found in women. A positive correlation between increasing age and the presence of IF was found. Additionally, brain atrophy greater than that expected by age was significantly more prevalent in participants without a parental history of AD.ConclusionsBrain MRIs of healthy middle-aged participants show a relatively high prevalence of IF even when study participants have been screened for subtle cognitive alterations. Most of our participants are first-degree descendants of patients with AD, and therefore these results are of special relevance for novel imaging studies in the context of AD prevention in cognitively healthy middle-aged participants.Trial registration numberNCT02198586.

Potentially serious incidental findings on brain and body magnetic resonance imaging of apparently asymptomatic adults: systematic review and meta-analysis

“…These 32 studies included 27 643 participants (range 2-5800 participants, mean/median age range 21-75 years, 14 037/27 643 (50.8%) men) imaged between 1985 and 2016 (supplementary figure 1, supplementary table 1). The included studies comprised eight of brain and body MRI, 21 22 23 24 25 26 27 28 22 of brain MRI, 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 and two of cardiac MRI. 51 52 No abdomen only studies were identified (supplementary table 1).…”

“…Studies were performed in Europe (20 studies, 21 22 23 24 25 27 28 29 31 34 36 37 39 40 41 43 44 47 48 52 17 702 participants), North America (six, 30 35 38 46 50 51 5789), Asia (four, 26 32 33 45 3576), and Australia (two, 42 49 576; supplementary table 1). All but three studies assessed images for incidental findings; one assessed imaging reports, 49 and two did not report on this.…”

Cognitive performance in patients with Mild Cognitive Impairment and Alzheimer's disease with white matter hyperintensities: An exploratory analysis

“…Some studies have suggested that age is strongly related to WMH. 12 , 55 Together with age, WMH are risk factors for the development of neurodegenerative diseases such as AD. 23 , 55 However, the explanatory model shows that age has a small percentage of explanation.…”

“… 23 Brain atrophy also increases significantly with advancing age. 12 Thus, it is necessary to understand which structural, cognitive and sociocultural factors are related to the profile of MCI patients with greater vascular components. Therefore, there is still a lack of information allowing the establishment of this explanatory cognitive profile for patients with MCI and dementia due to AD with greater WMH.…”

White matter hyperintensities mediate gray matter volume and processing speed relationship in cognitively unimpaired participants

“…(Longstreth et al, 1996) and are thought to have a vascular etiology, although their histopathological substrate might be heterogeneous as shown by pathological studies (Mortamais, Artero, & Ritchie, 2014;Prins & Scheltens, 2015) as well as by microstructural characterization of WMH with diffusion-weighted MRI imaging (Bastin et al, 2009;Wardlaw, Valdés Hernández, & Muñoz-Maniega, 2015;Zhong & Lou, 2016). Even they are relatively frequent in asymptomatic individuals (Arvanitakis et al, 2016;Birdsill et al, 2014;Brugulat-Serrat et al, 2017;Kloppenborg, Nederkoorn, Geerlings, & van den Berg, 2014), WMH burden has been shown to exert a negative impact on cognition (Arvanitakis et al, 2016;Bolandzadeh, Davis, Tam, Handy, & Liu-Ambrose, 2012;Jiang et al, 2018;Lampe et al, 2017) mainly in executive function (EF) (Desmond, 2002;de Groot et al, 2000;Jiang et al, 2018;Kloppenborg et al, 2014;Ramirez, McNeely, Scott, Stuss, & Black, 2014). WMH also increase the risk of cognitive decline and Alzheimer's disease (AD), contributing to its progression and severity (Habes et al, 2016;Smith et al, 2008).…”