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[P4–144]: CLINICAL IMAGING, COGNITIVE, AND GENETIC RISK PROFILES IN INCIDENT MCI FOR THE PREDICTION OF LONG‐TERM NEUROPATHOLOGICAL OUTCOMES AT AUTOPSY
Author(s) -
Jicha Gregory A.,
AlJanabi Omar,
Bahrani Ahmed,
Bardach Shoshana,
CabanHolt Allison M.,
Murphy Ronan,
Abner Erin L.,
Nelson Peter T.
Publication year - 2017
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2017.06.2010
Subject(s) - atrophy , apolipoprotein e , autopsy , medicine , hyperintensity , cognition , cardiology , psychology , temporal lobe , neuroimaging , cognitive decline , pathology , disease , magnetic resonance imaging , dementia , psychiatry , radiology , epilepsy
Background:The neuropathological substrates of incident mild cognitive impairment (MCI) are heterogeneous, even when MCI subtypes are classified according to up-to-date clinical criteria. The present study investigates the predictive accuracy of brain imaging, cognitive test profiles, and ApoE status, in relation to autopsy-confirmed neuropathological outcomes focusing on Alzheimer’s (AD) and cerebrovascular disease (CVD).Methods:Clinical cognitive test profiles, brain imaging, and ApoE genotypewere available on 105 participants from a community based sample with incident MCI. Demographic, semi-quantitative imaging (Fazekas scale for CVD and Scheltens score for medial temporal lobe atrophy as a surrogate for AD), cognitive profile by domain (memory, attention/executive, language), and ApoE genotype at time of incident MCI were evaluated in relation to eventual neuropathological outcomes in 34 subjects with subsequent autopsy that included analysis of AD and CVD features (mean time from MCI diagnosis to death 4.1 years, range 0-14 years).Results:There were no baseline differences between subjects with and without AD or CVD neuropathological changes for demographic, ApoE, or imaging variables, with the exception of increased global cerebral atrophy (p<0.05) and white matter hyperintensities (p<0.001) for the subjects with neuropathological CVD diagnoses. Only ApoE e4 status (65% correct classification; p<0.05) or the presence of any one imaging, cognitive, ApoE genotype risk (71% correct classification; p<0.01) predicted AD pathology at autopsy. Imaging evidence of CVD at the time of MCI diagnosis (79% correct classification; p<0.005) or the presence of any one imaging, cognitive, or ApoE genotype risk (76% correct classification; p<0.05) predicted CVD pathology at autopsy. Conclusions: Genetic risk and clinical imaging outperformed cognitive test profiles at first diagnosis of MCI in the prediction of the eventual neuropathological outcome. These results suggest that utilization of routine clinical tests, covered by most third party payers, as biomarkers for the prediction of long term outcomes in MCI is feasible.