MRI, CSF Biomarkers Predictive of Alzheimer's Dementia Risk

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Abnormal findings on MRI and in CSF may help indicate risk of progression to dementia in patients with MCI.
Abnormal findings on MRI and in CSF may help indicate risk of progression to dementia in patients with MCI.

Abnormal cerebrospinal fluid (CSF) and magnetic resonance imaging (MRI) findings are highly predictive of Alzheimer disease (AD) dementia risk in patients with mild cognitive impairment, according to a study published in JAMA Neurology.

Investigators analyzed patient data from the Amsterdam Dementia Cohort, including only patients with mild cognitive impairment (n=525). Specifically, the researchers examined patient characteristics, such as age, gender, Mini-Mental State Examination (MMSE) score, and MRI scans to determine associative risk for AD dementia.

The investigators found that younger men with an MMSE score of 29 had a lower risk for 3-year progression to AD dementia compared with older women with a 24 MMSE score (26% [95% CI, 19%-34%] vs 76% [95% CI, 65%-84%], respectively). 

Abnormal MRI results were associated with an 86% (95% CI, 71%-95%) progression to disease risk at 3 years and a 27% (95% CI, 17%-41%) progression to disease risk at 1 year. Normal MRI results correlated with 3- and 1-year progression to disease risks of 18% (95% CI, 13%-27%) and 3% (95% CI, 2%-5%).

In addition, abnormal CSF test results were associated with 3- and 1-year progression to AD dementia risk of 82% (95% CI, 73%-89%) and 26% (95% CI, 20%-33%), respectively. Lower 3- and 1-year progression to disease risk was found in the presence of normal CSF results (6% [95% CI, 3%-9%] and 1% [95% CI, 0.5%-2%], respectively).

The average follow-up in this study was 2.4 years, which may be too short to provide insight into longer-term progression to disease risks in this cohort. In addition, the investigators note that the generalizability of the findings remains a current challenge.

Despite these limitations, the prognostic models used in this study “show how biomarker research can be translated into clinical practice in a tractable manner” and may “help determine AD dementia and any type of dementia in patients with mild cognitive impairment at the individual level.”

Reference

van Maurik IS, Zwan MD, Tijms BM; Alzheimer's Disease Neuroimaging Initiative. Interpreting biomarker results in individual patients with mild cognitive impairment in the Alzheimer's Biomarkers in Daily Practice (ABIDE) project [published online October 16, 2017]. JAMA Neurol. doi:10.1001/jamaneurol.2017.2712

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