Correlations between Z‐scores of VSRAD and regional cerebral blood flow of SPECT in patients with Alzheimer's disease and mild cognitive impairment

Abstract

Aims:The purpose of the present study was to investigate whether there were correlations between atrophy of the entorhinal cortex and individual regional cerebral blood flow (rCBF) in patients with Alzheimer's disease (AD) and amnestic mild cognitive impairment (MCI) to better clarify the relationships between morphological and functional changes in AD.Methods: Twenty-six patients including sixteen AD and 10 amnestic MCI patients were enrolled. Z scores of voxel-based specific regional analysis system for AD (VSRAD) were determined to assess the degree of atrophy of the entorhinal cortex. Single-photon emission computed tomography (SPECT) and 3-D stereotaxic region of interest template (3DSRT) were used to quantify absolute rCBF.Results: The Z scores of the entorhinal cortex were found to have significant negative correlations with the absolute rCBF in the bilateral hippocampus, thalamus and temporal regions. A negative correlation between Z scores and rCBF of the cerebellum region, especially on the right side, was also noted.Conclusions: Atrophy of the entorhinal cortex had an obvious functional relationship with rCBF changes in the hippocampus, thalamus, temporal lobe and cerebellum in AD and MCI patients, which was attributed to their close anatomical and physiological connections.Key words: Alzheimer's disease, entorhinal cortex, mild cognitive impairment, regional cerebral blood flow, voxel-based specific regional analysis system for Alzheimer's disease. A LZHEIMER'S DISEASE (AD) is a neurodegenerative disorder characterized by progressive cognitive functional decline and behavioral disturbances, and remains the most common type of dementia. The entorhinal cortex, a portion of the anterior parahippocampus gyrus, is considered to be the prime site of neuropathological changes in the earliest stages of AD.1 The size of the entorhinal cortex was shown to be a useful index to discriminate patients with mild AD from healthy controls, as well as being a sensitive predictor of conversion to AD in traditional regions of interest (ROI) studies of magnetic resonance imaging (MRI).2 The atrophy rate in the entorhinal cortex has been found to be higher than that of the hippocampus, consistent with the view that AD pathology begins in the entorhinal cortex. Previous MRI studies were based on ROI analysis, which is, however, both time-consuming and observer dependent. Recently, a new method of voxel-based morphometry (VBM) has been developed and has overcome many of the limitations of ROI analysis, automatically mapping any gray matter loss on a voxel-by-voxel basis after anatomic standardization based on statistical parametric mapping (SPM).4 VBM confirmed temporal lobe atrophy in AD, and it was reported to be more accurate than ROI-based analysis for discriminating mild to moderate AD patients from controls. 5,6 Subsequently,

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“…SPECT showed diminished blood flow to the parietal lobes bilaterally, and the hippocampus had become atrophic. Her Z score of VSRAD was 3.2 [3]. Thus, she was suspected of having AD, and we prescribed donepezil hydrochloride.…”

“…The Z score of VSRAD was 1.33, so AD was interpreted as negative [3]. However, the level of Aβ40 was 2,430 pmol/l, Aβ42 was 155 pmol/l and t-tau was 645 pg/ml in CSF.…”

“…In addition, we investigated whether the patients were suffering from Alzheimer's disease (AD) by examination with single-photon emission computed tomography (SPECT) and Z scores of voxel-based specific regional analysis system for AD (VSRAD) on MRI [3]. …”

Relationship between Atrophy of the Medial Temporal Areas and Cognitive Functions in Elderly Adults with Mild Cognitive Impairment

“…The VSRAD analysis revealed that Z-scores indicating probable AD and amnestic MCI patients averaged 1.94 ± 1.24 (ranging from 0 to 4.69) [22]. Subjects exhibiting MTA-ERC atrophy as well as probable AD were included in the present MCI study.…”

“…The VSRAD has been shown to achieve high accuracy (87.8%) in discriminating patients in the very early stages of AD with MCI from normal control subjects using Z-scores [21]. Atrophy of the MTA-ERC was indicated by VSRAD to exhibit a clear functional relationship with blood flow changes in the hippocampus, thalamus and temporal lobe, which were suggested to be closely related to inter-regional anatomical and physiological connections [22]. In cognitive function, Nagata et al [23] reported that Z-scores of the VSRAD was associated with executive function, although there was no relationship between Z-scores and memory function which was assessed by the Mini-Mental State Examination (MMSE) in the amnestic MCI and early AD patients.…”