The usefulness of visual rating of posterior atrophy in predicting rapid cognitive decline in Alzheimer disease: A preliminary study

Abstract

Background Approximately 10% to 30% of Alzheimer disease (AD) patients progress rapidly in severity and become more dependent on caregivers. Although several studies have investigated whether imaging biomarkers such as medial temporal atrophy (MTA) and posterior atrophy (PA) are useful for predicting the rapid progression of AD, their results have been inconsistent. Objective The study aims to investigate the association of visually rated MTA and PA with rapid disease progression in AD. Methods This was a retrospective cohort study of 159 AD patients who were initially diagnosed with mild AD and were followed for 1 year to determine whether they progressed rapidly (a decrease of three points or more on the Mini‐Mental State Examination over 1 year). We used 5‐point and 4‐point visual rating scales to assess MTA and PA, respectively. MTA and PA scores for each patient were dichotomized as normal (without atrophy) or abnormal (atrophy). We performed a logistic regression analysis to determine the odds ratios (ORs) of MTA and PA for rapid disease progression with adjustment for covariates. Results Within the study population, 47 (29.6%) patients progressed rapidly. Visual assessment of the magnetic resonance imaging (MRI) scans revealed that 112 patients (70.4%) showed MTA, whereas 80 patients (50.3%) showed PA. The ORs with 95% confidence intervals for MTA and PA were 1.825 (0.819‐4.070) and 2.844 (1.378‐5.835), respectively. The association of visually assessed PA, but not MTA, with rapid progression was significant after adjustment for covariates. Conclusion In patients with mild AD, visual assessment of PA exhibits independent predictive value for rapid disease progression.

Plasma neurofilament light chain levels and cognitive testing as predictors of fast progression in Alzheimer’s disease

“…in AD. 33 Since CDT also taps into other cognitive domains such as planning and executive functions, 34,35 worse scores at baseline CDT might reflect a wider, albeit slight, multi-domain cognitive impairment in FAST rather than in SLOW decliners, as previously discussed. 4 The third independent predictor of FAST decline in our algorithm was plasma NfL: at baseline, higher plasma NfL levels were associated with an increased risk of FAST decline over time.…”

“…Conversely, poor performances at CDT reflect an impairment of visuospatial skills, mainly relying upon the functioning of the parietal lobe, 30 which is involved early in the disease course 31 . Several connectivity studies have shown that the posterior network, including the posterior brain regions, was selectively impaired in AD 32 ; accordingly, posterior atrophy, mainly driven by parietal lobe atrophy, was demonstrated to be strongly associated with rapid cognitive decline in AD 33 . Since CDT also taps into other cognitive domains such as planning and executive functions, 34,35 worse scores at baseline CDT might reflect a wider, albeit slight, multi‐domain cognitive impairment in FAST rather than in SLOW decliners, as previously discussed 4 …”

Association between T1w/T2w ratio in white matter and cognitive function in Alzheimer’s disease

“…In the current study, there was a trend for some cortical regions (left pars triangularis, P-value = 0.05, T-value = − 1.941; right posterior cingulate, P-value = 0.05, T-value = − 1.931), but they were not statistically significant. Considering the sample size of previous studies 53 – 55 , we attributed our findings on cortical thickness to the small sample size. However, with this sample size and statistical power, we identified additional associations between the WM T1w/T2w ratio and cognition and disease progression, which were not identified using cortical thickness values.…”

A multimodal, longitudinal study of cognitive heterogeneity in early‐onset Alzheimer's disease

“…It has been suggested that APOE ɛ4 is a factor that slows cognitive decline in AD [33,34]. Moreover, atypical forms of AD with executive and language impairments [35] or with pronounced atrophy in the posterior cerebral area [36] have both been linked to more rapid decline. These characteristics were all observed in C2.…”