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    Drsarchivneurol 1997

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    Sandy KOLBASI

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    © All Rights Reserved
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    of 10
    “EEE Selective Cortical and Hippocampal Volume Correlates of Mattis Dementia Rating Scale in Alzheimer Disease Rosemary Fama, PhD; Edith V. Sullivan, PhD; Paula K. Shear, PhD; Laura Marsh, MD; Jerome A. Yesavage, MD; Jared R. Tinklenberg, MD: Kelvin O. Lim, MD; Adolf Pffferbaum, MD Objective: To examine whether each of the 5 Mattis Dementia Rating Scale (DRS) scores related to mag- netic resonance imaging~derived volumes of specific cortical or limbic brain regions in patients with Alzheimer disease (AD). Designs Relations between DRS measures and regional brain volume measures were tested with bivariate and multivariate regression analyses. Setting: The Aging Clinical Research Center ofthe Stan- {ford (Calif) University Department of Psychiatry and Be- hhavioral Science and the Geriatric Psychiatry Rehabili- tation Unit ofthe Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif Patients and Other Participants: Fifty patients with possible or probable AD. Magnetic resonance imaging data from 136 healthy control participants, age 20 0 years, were used to correct brain volumes for normal variation arising from intracranial volume and age. Main Outcome Measures: The DRS scores and vol- umes of regional cortical gray matter and of the hippo- campus. Resultes Memory scores of the patients with AD were selectively related to hippocampal volumes, tention and construction scores were related to several ante- rior brain volume measures, with attention showing a significantly greater association to right than left hemi- sphere measures. Initiation/perseveration scores were not significantly correlated with any measure of regional gray matter volume, but performance was related to prefrontal sulcal widening, with a greater association with the left chan right sulcal volume. Conclusions: Certain DRS subtests are predictably correlated with selective regional brain volumes in AD. The specific relation berween memory and hippo- campal volumes and the nonsignificant relations between memory and regional cortical volumes sug- gest a dissociation between cortical and hippocampal contributions to explicit memory performance. Arch Neurol, 1997;54:719-728 EUROIMAGING studies of Alzheimer disease (AD) provide in vivo evidence for enlargement of ven- tricularand cortical suleal volumes'? and complementary deficits in cortical gray matter volume throughout much of the brain.™* The regional pattern of brain volume abnormalities in patients ‘with AD isdistine from that seen in normal agingand in another neurodegenerative dis- order, Parkinson disease,” and the most ‘marked deficits re in the medial temporal regions *#"" These neuroradiological find {ngsare oonsstentwithpastmortem evidence of gray matter atrophy in the hip; and association cortices of AD brains.'*!* ‘Whether the extent of tisste-volume defi- citsin elective brain regionsin AD srelated cogniivedeficitsisonly From the Department of Paychiatry and Behavioral Scences, Sanford Universtty School of Medicine, Stanford Calif (Drs Fama, Sullivan, ‘Shear, Marsh, Yesavage, Tinklenberg, Lim, and Pyeferbaum); the Psychiarry Service, Veterans Affairs Palo ‘Alto Health Care System, Palo ‘Alt, Calif (Drs Yesavage Tinklenberg, and Lim) and the [Neuropsychiatry Program, SRI International, Menlo Park, Calif (Drs Sulivan and Pfefferbaum), Dr Shear Is now ln the Department of Paychology, University of Cincinnat.Cincinatl, ON toobservable specifi sparsely established, 2 ‘The Mattis Dementia Rating Scale (DRS) is widely used in clinical and re search settings as a global measure of cog- nitive functioning inpatients with AD. The DRS is composed of 5 subscales (memory, initation/perseveration, attention, concep- tualization, and construction) each of which assesses a different cognitive domain, and ‘total score, which provides an overall in- dex of dementia severity. The DRS has greater sensitivity to longitudinal cogni- tive decline in AD than either of 2 other commonly used assessment tools, the Blessed information-Memory-Concentra- tion test and the Mini-Mental State Exami- nation (MMSE). The DRS has reasonably high power to discriminate AD from other illnesses The indices thought to best discriminate patients with AD from healthy older individuals are the memory and initiation/perseveration subscales”? METHODS AND PARTICIPANTS METHODS Paricipansin hist include 50 paces with AD rere from the Geriatric Rehabilitation UnitandtheNa- ‘onal insiutof Mental Health Aging Clinical Research Cen- ter, both cated atthe Veteran flats Pal Alto Health Care ‘System, Palo Alto, Cai. Allpaents withAD met the Natonal Insitute of Neurlogieal and Communicative Diseases and Sitoke-Altheimer Disease and Related Disorders Association tena for probable AD" Normal cnolsubjecs sasing the adult age range (20-84 years of age) were Wed aa refers ence group or te MRl volumetric measures, These subjects, ‘orasubsetof them, have fommed the nonns fr other stidies ‘fom our laboratory "=" The normal contol group consisted of 95 men and 41 women fr the axial protocol and 84 men and28 women forthe coronal protocol. Sreenng forallpar- ‘iipans included a paychian interview and medical exami- ‘ation, Subjects were excludedifthey hada histor fpayehi- sxticorneurological disorder unrelated to their diagnos (eg, sake, ose ead injury) pastor resent alebolor drugabuse ordependence oraserousmedical condition. iiormcscon- sent was obtained fromall participants o their conservators Demographic information forthe AD group sas follows arc Men (30) ame tony naa) star elton y wes $2 ‘Age at onset of symptoms, y 66.0(8.0) 49-83 Prana ese" mae) ee SE sae 154) 128 Veeanday ata cot m25 an ® Nato At aig it t Wc aa iene DEMENTIA RATING SCALE The DRS is composed of5 subscales: memory (recall nd recognition of verbal an visual stall after immediate and short delays), inidation/perseveration (semantic [supermar- ket] ueney, motor fluency, and’ tion), attention orward and backward digi span, abiltytofollow commands, ‘and matchingro sample timull with distractor), conceptu- alization (abstraction from verbally and visually presented stimall), and construction (copy of geometric figures and signature wring). MRI SCANNING AND QUANTIFICATION ‘Axial Protocol Acquisition Parameters. Subjects were scanned with 15-7 MBI scanners (Signa, General Elecre, Milwaukee, Wis) lage acqtstion prsedures and parameters have ben described in deta °° Axial MR seans were Sram thick (2.5-mm skip) snd were acquired in an oblique plane us- inga spin-echo sequence (20- nd 80-ailisevond echoes) whe 2m ldo wew and 2560256 mar Aen ‘Son was gated to every other cardiac eyce for an ellee- tive repetidon time of re than 2400 alleconds with 1 Cxctation foreach of 256 phase encodes, ‘Allimages were stored on magnetic tape and trans- fered to optical disks for analysis. For each subject the Index slice was identified as the most inferior slice above the level ofthe orbits, where the anterior horns ofthe lt ceral ventricles could be seen bilaterally. Seven consecu- {vee began wih he sone ota and proceeding superiorly, were analyzed foreach sub- Jeet. The index slice or the slice below it was used for quan- ‘ification ofthe third ventricle Regional Divisions and Segmentation of images Each MI ce was segmented inf certrospinalfukd (CSP, ‘pay mate and whe mae comparanents, sing asem Somated nage analy technique "To separate the ce ‘ebrl hemispheres amine wat denwn mantaly on exch Slice Each hier ao was dvded nts inner 39% region (tacit qunaleaton of cenzal SP, which arse pr taal bat not exasvely rom the ler venice) and router 49% (oui quantiication ofthe corte ‘Se volumes and sla CSE) Theimages were dived acorn to anatomic and mais tnd a prod geomenie ero achive sundae ‘egal dso ofthe nin images The corteal taverns du ihr eachinage was dedi 6 rome cal defined egonsofierest which rough contponccd telbarsntomy The eons inet ecompa ce {revalumecf the col labes fe which they were named bat provided eb baste fo dding coral scone Tolorm hese dvsonscachMRlsice ws dvdedinio4 Bensty coronal panes which pase rough theron fer cei tego cerca on postsiorexreme of splenism ofthe corpscalons a Fd betwen them. The fis plane erable x bound yr prefolregon, From tse quadransand sis, wedevsed coral eon, defined sll prfontal— ‘Gemostanteroguadnfall sles, which inde nox cle preronal one ronal~—the sbterr mide quad tantol aces 30 tempore aneioc idle qushatoflees Land whch nluded cane ‘pero temporal yrassnd te mos posteroretensofthe froma lobes bee ofthe sper emporsgrspor ‘conser tempor she poner mile uci ostes ‘and whichinaded he pontcroniperor tempor gs sndasnallporconol theater exerts ofthe preaches stare sopeiortenpora gyro anerior sia Posterior mide undress end posteriori Secipial~thematpoterior quads faces wi shotncuded mach ofthe occptal lobes (Figure) Coronal Protocol {A detailed description of the acquisition methods, ana- tomlcal borders, and reliability used in our laboratory 10 ‘examine the temporal lobes and hippocampus has been re- ported! Summaries are presented below. ‘Acquisition Parameters. With this protocol, 2 conlguous ‘3-mrn-thick coronal images were acquired usingamuldecho, ‘Dow-compensatd, cardiac gad pulse sequence (echotime=40 ‘and 0 milliseconds; effective repetition time, 2800 milisec- ‘onds) witha 24-cm field of view, l excitation, anda 256x256 ‘matrix. The plane of mage acquisition was oriented perpen-

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