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Principal Investigator  
Principal Investigator's Name: Young Ho Park
Institution: Seoul National University Bundang Hospital
Department: Department of Neurology
Country:
Proposed Analysis: 1. Title Prognosis based on visual rating of medial temporal and posterior atrophy in mild cognitive impairment patients 2. Purpose To evaluate the predictive value of the presence of medial temporal atrophy (MTA) and posterior atrophy (PA) for the progression to dementia in patients with mild cognitive impairment (MCI). 3. Background It is known that about 5 to 10 percent of MCI patients progress to dementia in a year. Alzheimer's disease (AD) is the most common cause of MCI in elderly patients. MCI patients with positive biomarkers for AD have a higher risk of progression to dementia. Many studies have shown that visually rated MTA on MRI is a useful imaging marker for prediction of progression from MCI to dementia and is widely applied in clinical practice. However, substantial MCI patients without MTA still progress to dementia. Previous neuroimaging studies have reported that parietal lobes are involved early during conversion from MCI to AD. Recently, a visual rating scale for PA was developed to discriminate AD patients and controls. With regard to prediction of conversion to AD in MCI patients, there was a strong association of the MTA scale with conversion to AD, with a borderline statistically significant association for the PA scale. In this study, we will categorize MCI patients into four groups according to the presence of MTA or PA and compare the progression rate to dementia. We will also compare CSF biomarkers between the groups. 4. Outcome 1) Progression to dementia 2) CSF Abeta1-42, p-tau, t-tau 5. Main variable 1) MTA: MTA was assessed using a visual rating scale developed by Scheltens et al, which has been commonly used for clinical and research purposes. It rates atrophy on a 5-point scale from 0 (no atrophy) to 4 (severe atrophy) based on the height of the hippocampal formation and the width of the choroidal fissure and the temporal horn. Scores for the right and left hemispheres were averaged in each patient. Then, scores were dichotomized into normal (no atrophy) and abnormal (atrophy), with an averaged score of 1.5 or more being considered abnormal. 2) PA: PA was rated according to the recently developed scale by Koedam et al, which has been shown to have good intra- and inter-rater reliability. It rates atrophy on a 4-point scale from 0 (no atrophy) to 3 (severe atrophy). Scores for the right and left hemispheres were averaged in each patient. Then, scores were dichotomized into normal (no atrophy) and abnormal (atrophy), with an averaged score of 1.5 or more being considered abnormal. 6. Covariates Age (baseline), Sex, Follow-up peridods (month), APOE ε4 genotype 7. Statistical hypothesis Progression rate to dementia is different between four groups according to the presence of MTA or PA. 8. Statistical analysis To examine the HR of the presence of MTA or PA for progression to dementia, we will perform the Cox regression analysis with follow-up time as a time variable and progression to dementia as a status variable. Multivariate analysis will be performed with adjustment for covariates which were clinically relevant or which were statistically significant from univariate Cox regression analysis. We will also compare the CSF biomarkers between the group using ANOVA.
Additional Investigators