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April 01, 1999; 52 (7) Article

Prediction of AD with MRI-based hippocampal volume in mild cognitive impairment

C.R. Jack, R.C. Petersen, Y.C. Xu, P.C. O’Brien, G.E. Smith, R.J. Ivnik, B.F. Boeve, S.C. Waring, E.G. Tangalos, E. Kokmen
First published April 1, 1999, DOI: https://doi.org/10.1212/WNL.52.7.1397
C.R. Jack Jr.
From the Departments of Diagnostic Radiology (Drs. Jack and Xu)Neurology (Drs. Petersen, Boeve, and Kokmen), Health Sciences Research (P.C. O’Brien and S.C. Waring), Psychiatry and Psychology (G.E. Smith and R.J. Ivnik), and Internal Medicine (Dr. Tangalos), Mayo Clinic and Foundation, Rochester, MN.
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R.C. Petersen
From the Departments of Diagnostic Radiology (Drs. Jack and Xu)Neurology (Drs. Petersen, Boeve, and Kokmen), Health Sciences Research (P.C. O’Brien and S.C. Waring), Psychiatry and Psychology (G.E. Smith and R.J. Ivnik), and Internal Medicine (Dr. Tangalos), Mayo Clinic and Foundation, Rochester, MN.
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Y.C. Xu
From the Departments of Diagnostic Radiology (Drs. Jack and Xu)Neurology (Drs. Petersen, Boeve, and Kokmen), Health Sciences Research (P.C. O’Brien and S.C. Waring), Psychiatry and Psychology (G.E. Smith and R.J. Ivnik), and Internal Medicine (Dr. Tangalos), Mayo Clinic and Foundation, Rochester, MN.
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P.C. O’Brien
From the Departments of Diagnostic Radiology (Drs. Jack and Xu)Neurology (Drs. Petersen, Boeve, and Kokmen), Health Sciences Research (P.C. O’Brien and S.C. Waring), Psychiatry and Psychology (G.E. Smith and R.J. Ivnik), and Internal Medicine (Dr. Tangalos), Mayo Clinic and Foundation, Rochester, MN.
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G.E. Smith
From the Departments of Diagnostic Radiology (Drs. Jack and Xu)Neurology (Drs. Petersen, Boeve, and Kokmen), Health Sciences Research (P.C. O’Brien and S.C. Waring), Psychiatry and Psychology (G.E. Smith and R.J. Ivnik), and Internal Medicine (Dr. Tangalos), Mayo Clinic and Foundation, Rochester, MN.
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R.J. Ivnik
From the Departments of Diagnostic Radiology (Drs. Jack and Xu)Neurology (Drs. Petersen, Boeve, and Kokmen), Health Sciences Research (P.C. O’Brien and S.C. Waring), Psychiatry and Psychology (G.E. Smith and R.J. Ivnik), and Internal Medicine (Dr. Tangalos), Mayo Clinic and Foundation, Rochester, MN.
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B.F. Boeve
From the Departments of Diagnostic Radiology (Drs. Jack and Xu)Neurology (Drs. Petersen, Boeve, and Kokmen), Health Sciences Research (P.C. O’Brien and S.C. Waring), Psychiatry and Psychology (G.E. Smith and R.J. Ivnik), and Internal Medicine (Dr. Tangalos), Mayo Clinic and Foundation, Rochester, MN.
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S.C. Waring
From the Departments of Diagnostic Radiology (Drs. Jack and Xu)Neurology (Drs. Petersen, Boeve, and Kokmen), Health Sciences Research (P.C. O’Brien and S.C. Waring), Psychiatry and Psychology (G.E. Smith and R.J. Ivnik), and Internal Medicine (Dr. Tangalos), Mayo Clinic and Foundation, Rochester, MN.
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E.G. Tangalos
From the Departments of Diagnostic Radiology (Drs. Jack and Xu)Neurology (Drs. Petersen, Boeve, and Kokmen), Health Sciences Research (P.C. O’Brien and S.C. Waring), Psychiatry and Psychology (G.E. Smith and R.J. Ivnik), and Internal Medicine (Dr. Tangalos), Mayo Clinic and Foundation, Rochester, MN.
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E. Kokmen
From the Departments of Diagnostic Radiology (Drs. Jack and Xu)Neurology (Drs. Petersen, Boeve, and Kokmen), Health Sciences Research (P.C. O’Brien and S.C. Waring), Psychiatry and Psychology (G.E. Smith and R.J. Ivnik), and Internal Medicine (Dr. Tangalos), Mayo Clinic and Foundation, Rochester, MN.
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Citation
Prediction of AD with MRI-based hippocampal volume in mild cognitive impairment
C.R. Jack, R.C. Petersen, Y.C. Xu, P.C. O’Brien, G.E. Smith, R.J. Ivnik, B.F. Boeve, S.C. Waring, E.G. Tangalos, E. Kokmen
Neurology Apr 1999, 52 (7) 1397; DOI: 10.1212/WNL.52.7.1397

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Abstract

Objective: To test the hypothesis that MRI-based measurements of hippocampal volume are related to the risk of future conversion to Alzheimer’s disease (AD) in older patients with a mild cognitive impairment (MCI).

Background: Patients who develop AD pass through a transitional state, which can be characterized as MCI. In some patients, however, MCI is a more benign condition, which may not progress to AD or may do so slowly.Patients:— Eighty consecutive patients who met criteria for the diagnosis of MCI were recruited from the Mayo Clinic Alzheimer’s Disease Center/Alzheimer’s Disease Patient Registry.

Methods: At entry into the study, each patient received an MRI examination of the head, from which the volumes of both hippocampi were measured. Patients were followed longitudinally with approximately annual clinical/cognitive assessments. The primary endpoint was the crossover of individual MCI patients to the clinical diagnosis of AD during longitudinal clinical follow-up.

Results: During the period of longitudinal observation, which averaged 32.6 months, 27 of the 80 MCI patients became demented. Hippocampal atrophy at baseline was associated with crossover from MCI to AD (relative risk [RR], 0.69, p = 0.015). When hippocampal volume was entered into bivariate models—using age, postmenopausal estrogen replacement, standard neuropsychological tests, apolipoprotein E (APOE) genotype, history of ischemic heart disease, and hypertension—the RRs were not substantially different from that found univariately, and the associations between hippocampal volume and crossover remained significant.

Conclusion: In older patients with MCI, hippocampal atrophy determined by premorbid MRI-based volume measurements is predictive of subsequent conversion to AD.

  • Received October 13, 1998.
  • Accepted in final form January 27, 1999.
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