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A Comprehensive Visual Rating Scale for Predicting Progression from Mild Cognitive Impairment to Dementia in Patients with Alzheimer's Pathology or Suspected Non-Alzheimer's Pathology

Dementia and Neurocognitive Disorders 2020년 19권 4호 p.129 ~ 139
박상원, 김성헌, 박정훈, 장재원, 김상윤,
소속 상세정보
박상원 ( Park Sang-Won ) - Kangwon National University School of Medicine Department of Neuroscience
김성헌 ( Kim Seong-Heon ) - Kangwon National University Hospital Department of Neurology
박정훈 ( Park Jeong-Hoon ) - Kangwon National University Hospital Department of Neurology
장재원 ( Jang Jae-Won ) - Kangwon National University School of Medicine Department of Neuroscience
김상윤 ( Kim Sang-Yun ) - Seoul National University Bundang Hospital Department of Neurology

Abstract


Background and Purpose: To identify biomarkers for prediction of the progression to dementia in mild cognitive impairment (MCI) patients, evaluation of brain structure changes has been validated by a comprehensive visual grading scale (CVRS) through magnetic resonance imaging (MRI). In this study, we specifically elucidated for the cognitive change of MCI patients classified based on AT(N) pathological status classification during the follow-up period of 3 years through the CVRS.

Methods: The 301 patients with initial MCI visited at least once for follow-up period. The data used in this study were obtained from the Alzheimer's disease (AD) Neuroimaging Initiative study. Brain atrophy was assessed by CVRS using MRI. AT(N) profiles were classified by cerebrospinal fluid abnormality. Based on the AT(N) assessment, all individuals in this study were divided into 3 groups (normal state biomarker, suspected non-Alzheimer's pathology [SNAP], or Alzheimer's continuum). The cox regression was used to analyze the hazard ratios of CVRS for progression to dementia.

Results: Sixty-three progressed and 238 remained stable to dementia and the CVRS (mean±standard deviation) had significant difference between progressive MCI and stable MCI (p<0.001). Univariate and multivariate cox regression results (p<0.001) showed the independence of initial CVRS as a predictor for the progression to dementia. Moreover, comparing the classified AT(N) pathology group, SNAP and AD, effectiveness of CVRS as a predictor was verified only in Alzheimer's continuum.

Conclusions: The initial CVRS score as a predictor of dementia progression was independently validated at the stage of Alzheimer's progression among AT(N) pathologically differentiated MCI.

키워드

Alzheimer's Disease; Mild Cognitive Impairment; Magnetic Resonance Imaging; Neuropathology

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