MRI measures of temporoparietal regions
show differential rates of atrophy during
R.S. Desikan, BA
B. Fischl, PhD
H.J. Cabral, PhD
T.L. Kemper, MD
C.R.G. Guttmann, MD
D. Blacker, MD
B.T. Hyman, MD
M.S. Albert, PhD
R.J. Killiany, PhD
Background: MRI studies have demonstrated differential rates of atrophy in the entorhinal cortex
and hippocampus during the prodromal phase of Alzheimer disease (AD). The current study was
designed to determine whether a broader set of temporoparietal regions show differential rates
of atrophy during the evolution of AD.
Methods: Sixteen regions of interest (ROIs) were analyzed on MRI scans obtained at baseline and
follow-up in 66 subjects comprising three groups: controls ? individuals who were cognitively
normal at both baseline and follow-up; nonconverters ? subjects with mild cognitive impairment
(MCI) at both baseline and follow-up; converters had MCI at baseline but had progressed to AD at
Results: Annualized percent change was analyzed with multivariate analysis of variance
(MANOVA), covaried for age. The MANOVA demonstrated an effect of group (p ? 0.004). Post
hoc comparisons demonstrated greater rates of atrophy for converters vs nonconverters for six
ROIs: hippocampus, entorhinal cortex, temporal pole, middle temporal gyrus, fusiform gyrus, and
of the same ROIs (and inferior parietal lobule). Rates of change in clinical status were correlated with
the atrophy rates in these regions. Comparisons between controls and nonconverters demonstrated
Conclusion: These results demonstrate that temporoparietal regions show differential rates of
atrophy on MRI during prodromal Alzheimer disease (AD). MRI data correlate with measures of
clinical severity and cognitive decline, suggesting the potential of these regions of interest as
antemortem markers of prodromal AD. Neurology®2008;71:819–825
AD ? Alzheimer disease; APC ? annualized percent change; CDR-SB ? Clinical Dementia Rating Sum of Boxes; CVLT ?
California Verbal Learning Test; MANOVA ? multivariate analysis of variance; MCI ? mild cognitive impairment; ROI ? region
of interest; SRT ? Selective Reminding Test.
Longitudinal MRI studies have focused on volumetric changes primarily in the hippocampus
and entorhinal cortex. Postmortem studies indicate that additional regions beyond hippocam-
pus and entorhinal cortex are involved in the early phases of Alzheimer disease (AD).1-5The few
longitudinal studies examining temporoparietal changes in subjects with mild cognitive im-
pairment (MCI) who progressed to AD found atrophy in inferior and middle temporal gyrus,
posterior cingulate, and precuneus,6and in medial temporal lobe and posterior cortical
Address correspondence and
reprint requests to Dr. Ronald J.
Killiany, Dept. of Anatomy and
Neurobiology, Center for
Biomedical Imaging, Boston
University School of Medicine,
Boston, MA 02118
e-Pub ahead of print on July 30, 2008, at www.neurology.org.
From the Department of Anatomy and Neurobiology (R.S.D., T.L.K., R.J.K.) and Center for Biomedical Imaging (R.J.K.), Boston University School
of Medicine; Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (B.F.), Department of Psychiatry (D.B., R.J.K.), and
Department of Neurology (B.T.H.), Massachusetts General Hospital; Computer Science and Artificial Intelligence Laboratory (B.F.), Massachusetts
Institute of Technology; Departments of Biostatistics (H.J.C.) and Environmental Health (R.J.K.), Boston University School of Public Health;
Department of Radiology (C.R.G.G., R.J.K.), Brigham and Women’s Hospital, Boston, MA; and Department of Neurology (M.S.A.), Johns
Hopkins University School of Medicine, Baltimore, MD.
Supported by grants from the National Institute on Aging (P01-AG04953), the National Center for Research Resources (P41-RR14075, R01-
RR16594, U24-RR021382), the National Institute for Biomedical Imaging and Bioengineering (R01-EB001550), the National Institute for
Neurological Diseases and Stroke (R01 NS052585), the BIRN Mophometric Project, and the Mental Illness and Neuroscience Discovery (MIND)
Disclosure: The authors report no disclosures.
Copyright © 2008 by AAN Enterprises, Inc.
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