Contribution of ¹H Spectroscopy to a Brief Cognitive-Functional Test Battery for the Diagnosis of Mild Alzheimer’s Disease

Abstract

Background/Aims: The diagnosis of mild or questionable Alzheimer’s disease (AD) depends on clinical criteria that often leave a margin for doubt. We aim to verify the diagnostic accuracy of amnestic mild cognitive impairment (aMCI) and AD with proton spectroscopy (¹H-MRS) combined with brief cognitive-functional scales. Methods: The relationship between ¹H-MRS of the posterior cingulate cortex and the cognitive performance in Mini Mental State Examination, Blessed-Roth Dementia Rating and Functional Assessment Staging of Alzheimer Disease scales were investigated in 25 AD, 10 aMCI and 33 normal control (NC) individuals. Results: The N-acetylaspartate (NAA)/creatine and myoinositol/NAA ratios distinguished AD patients from NC (p < 0.005), and added value in diagnostic accuracy and specificity by discriminant function analysis when combined to clinical diagnosis and simple neuropsychiatric scales; an increase of 3.7% (for aMCI patients) and of 5% (for AD individuals) was observed in diagnostic accuracy, and one of 5.5% (aMCI) and of 11.1% (AD) in specificity. Conclusion:¹H-MRS combined with brief cognitive-functional scales provided maximum diagnostic accuracy of AD patients, and can be useful when subtle cognitive and memory dysfunction is present.

Decreased Glutamate Levels in Patients with Amnestic Mild Cognitive Impairment: An sLASER Proton MR Spectroscopy and PiB‐PET Study

“…Earlier 1 H‐MRS studies in patients with aMCI, conducted using the conventional protocols, such as PRESS, showed that the 1 H‐MRS abnormalities identified in patients with aMCI were similar, but only milder compared to the abnormalities identified in patients with AD dementia . In patients with aMCI, the elevation in the myo ‐inositol level was shown to precede the decrease in the NAA level .…”

In vivo molecular imaging of neuroinflammation in Alzheimer's disease

“…; Silveira de Souza et al . ). Increased mI levels, whether or not an indication of gliosis cannot be directly linked to activation of microglia as there are no studies which have investigated the metabolic profile of microglia.…”

“…There is a lack of other studies seriously investigating this contention though it is widely quoted. Many studies have shown mI to be significantly increased in many brain areas including the hippocampal, occipital, parietal and posterior cingulate regions of AD patients compared to healthy controls (Huang et al 2001;Kantarci 2007;Watanabe et al 2010;Silveira de Souza et al 2011). Increased mI levels, whether or not an indication of gliosis cannot be directly linked to activation of microglia as there are no studies which have investigated the metabolic profile of microglia.…”

Meta-Analysis of Neurochemical Changes Estimated via Magnetic Resonance Spectroscopy in Mild Cognitive Impairment and Alzheimer's Disease

“…A total of 29 studies (Kantarci et al, 2000(Kantarci et al, , 2002(Kantarci et al, , 2007Chao et al, 2005;Rami et al, 2007;García et al, 2008;Olson et al, 2008;Wang et al, 2009Wang et al, , 2012Griffith et al, 2010;Watanabe et al, 2010;de Souza et al, 2011;Fayed et al, 2011Fayed et al, , 2014Zimny et al, 2011;Lim et al, 2012;Seo et al, 2012;Shiino et al, 2012;Yang et al, 2012;Targosz-Gajniak et al, 2013;Graff-Radford et al, 2014;Liu et al, 2014;Riese et al, 2015;Guo et al, 2016;Zeydan et al, 2017;Marjańska et al, 2019;Mitolo et al, 2019;Oeltzschner et al, 2019) investigated the ratio of metabolites in posterior cingulate with a sample size of 770 MCI patients, 585 AD patients, and 1,378 healthy controls. To be specific, 25 studies (Kantarci et al, 2000(Kantarci et al, , 2002(Kantarci et al, , 2007Chao et al, 2005;Rami et al, 2007;García et al, 2008;Olson et al, 2008;Wang et al, 2009Wang et al, , 2012Griffith et al, 2010;Watanabe et al, 2010;de Souza et al, 2011;…”