Accelerated Brain Atrophy on Serial Computed Tomography: Potential Marker of the Progression of Alzheimer Disease

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Abstract

Objective

The aim of this study was to validate computed tomography (CT)–based longitudinal markers of the progression of Alzheimer disease (AD).

Materials and Methods

We retrospectively studied 33 AD patients and 39 nondemented patients with other neurological illnesses (non-AD) having 4 to 12 CT examinations of the head, with over a mean (SD) of 3.9 (1.7) years. At each time point, we applied an automatic software to measure whole brain, cerebrospinal fluid, and intracranial space volumes. Longitudinal measures were then related to disease status and time since the first scan using hierarchical models.

Results

Absolute brain volume loss accelerated for non-AD patients by 0.86 mL/y2 (95% confidence interval [CI], 0.64–1.08 mL/y2) and 1.5× faster, that is, 1.32 mL/y2 (95% CI, 1.09–1.56 mL/y2) for AD patients (P = 0.006). In terms of brain volume normalized to intracranial space, the acceleration in atrophy rate for non-AD patients was 0.0578%/y2 (95% CI, 0.0389%/y2 to 0.0767%/y2), again 1.5× faster, that is, 0.0919%/y2 (95% CI, 0.0716%/y2 to 0.1122%/y2) for AD patients (P = 0.017). This translates to an increase in atrophy rate from 0.5% to 1.4% in AD versus to 1.1% in non-AD group after 10 years.

Conclusions

Brain volumetry on CT reliably detected accelerated volume loss in AD and significantly lower acceleration factor in age-matched non-AD patients, leading to the possibility of its use to monitor the progression of cognitive decline and dementia.

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