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From the Sheba Medical Center (Dr. Kidron), Tel-Aviv, Israel; the Cognitive Neurology Unit, Research Program in Aging (Dr. Black, B. Buck, J. Parker, and C. Szekely), Clinical Epidemiology and Health Care Research Program (Dr. Szalai), and Imaging-Bioengineering Research (Dr. Bronskill), Sunnybrook Health Science Centre, Toronto, Ontario, Canada; and the Institute of Mathematics and Computer Science (Dr. Stanchev), Bulgarian Academy of Sciences, Sophia, Bulgaria.
Address correspondence and reprint requests to Dr. Sandra E. Black, Head, Division of Neurology, Sunnybrook Health Science Centre, Room A421-2075 Bayview Avenue, North York, Ontario, Canada, M4N 3M5.
We determined topographic selectivity and diagnostic utility of brain atrophy in probable Alzheimer's disease (AD) and correlations with demographic factors such as age, sex, and education. Computerized imaging analysis techniques were applied to MR images in 32 patients with probable AD and 20 age- and sex-matched normal control subjects using tissue segmentation and three-dimensional surface rendering to obtain individualized lobar volumes, corrected for head size by a residualization technique. Group differences emerged in gray and white matter compartments particularly in parietal and temporal lobes. Logistic regression demonstrated that larger parietal and temporal ventricular CSF compartments and smaller temporal gray matter predicted AD group membership with an area under the receiver operating characteristic curve of 0.92. On multiple regression analysis using age, sex, education, duration, and severity of cognitive decline to predict regional atrophy in the AD subjects, sex consistently entered the model for the frontal, temporal, and parietal ventricular compartments. In the parietal region, for example, sex accounted for 27% of the variance in the parietal CSF compartment and years of education accounted for an additional 15%, with women showing less ventricular enlargement and individuals with more years of education showing more ventricular enlargement in this region. Topographic selectivity of atrophic changes can be detected using quantitative volumetry and can differentiate AD from normal aging. Differential effects of sex and years of education can also be detected by these methods. Quantification of tissue volumes in vulnerable regions offers the potential for monitoring longitudinal change in response to treatment.
Supported by grants from the Ontario Mental Health Foundation and the Medical Research Council of Canada. D.K. received fellowship support from Baycrest Centre for Geriatric Care and Sunnybrook Health Science Centre.
Presented in part at the 46th annual meeting of the American Academy of Neurology, Washington, DC, May 1994.
Received March 24, 1997. Accepted in final form June 18, 1997.
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