Hippocampus, caudate nucleus and entorhinal cortex volumetric MRI measurements in discrimination between Alzheimer’s disease, mild cognitive impairment, and normal aging

BackgroundStructural neuroimaging MR volumetric changes can predict progression of MCI to AD. Early effective treatment of MCI has been shown to delay institutionalization and improve cognition and behavioral symptoms.Aim of the workTo evaluate the role of volumetric MRI to identify a pattern of regional atrophy characteristic in differentiation between Alzheimer’s disease, Mild Cognitive Impairment, and Normal elderly control.Material and methodsThe regional ethics committee approved the study and written informed consent was obtained from all participants. Between April 2012 and May 2013, prospective study was conducted on 25 patients (18 males and 7 females) and 15 healthy elderly controls (9 males and 6 females) referred to the Radiodiagnosis Department from the Neuropsychiatry Department that had clinical manifestations of suspected cognitive impairment, we used the Mini Mental State Examination (MMSE) as a measure of general cognitive function and the total learning from the Auditory Verbal Total Learning Test (AVTOT) as a measure of memory performance. One year follow up of patients was done to assess the disease progress.ResultsTwenty-five patients were included in this study {Alzheimer disease (10 cases), MCI (15 cases)} and 15 healthy elderly controls. Mean MMSE scores were significantly lower in patients with Alzheimer’s disease compared with MCI and control cases (P < 0.001). Positive correlation (except left caudate nucleus) between gray matter volume reduction in MCI and AD in relation to elderly control and MMSE score was observed. The Auditory Verbal Learning Test (AVTOT) was significantly lower in patients with Alzheimer’s disease compared with MCI and control cases (P < 0.001). No significant differences were found between groups as regards age, sex, education or dominant hand. Significant gray matter volume reductions were found in both AD and MCI compared to healthy elderly control however no significant differences were found among MCI patients or AD patients. Sensitivity, specificity, PPV and NPV of caudate nucleus and hippocampal volume reduction in AD and MCI in relation to elderly control were higher than entorhinal cortex.ConclusionSemi-automated MR volumetric measurements can be used to determine atrophy in hippocampus, caudate nucleus and entorhinal cortex which aided in discrimination of healthy elderly control subjects from subjects with AD and MCI and predict clinical decline of MCI leading to increase the efficiency of clinical treatments, delay institutionalization and improve cognition and behavioral symptoms.