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From the Magnetic Resonance Unit (Drs. Schuff, Du, Amend, and Weiner), DVA Medical Center San Francisco; Departments of Radiology (Drs. Norman and Weiner), Neurology (Drs. Miller, Yaffe, and Weiner), Medicine (Dr. Weiner), and Psychiatry (Dr. Wolkowitz), University of California, San Francisco; MRI Unit (Dr. Capizzano), Fernández Hospital, Buenos Aires, Argentina; Department of Radiology (Dr. O’Neill), University of California, Los Angeles; and Department of Neurology (Dr. Jagust), University of California, Davis.
Address correspondence and reprint requests to Dr. Norbert Schuff, DVA Medical Center, 4150 Clement St. 114M, San Francisco, CA 94121; e-mail: nschuff{at}itsa.ucsf.edu
Background: Both AD and normal aging cause brain atrophy, limiting the ability of MRI to distinguish between AD and age-related brain tissue loss. MRS imaging (MRSI) measures the neuronal marker N-acetylaspartate (NAA), which could help assess brain change in AD and aging.
Objectives: To determine the effects of AD on concentrations of NAA, and choline- and creatine-containing compounds in different brain regions and to assess the extent NAA in combination with volume measurements by MRI improves discrimination between AD patients and cognitively normal subjects. Methods: Fifty-six patients with AD (mean age: 75.6 ± 8.0 years) and 54 cognitively normal subjects (mean age: 74.3 ± 8.1 years) were studied using MRSI and MRI.
Results: NAA concentration was less in patients with AD compared with healthy subjects by 21% (p < 0.0001) in the medial temporal lobe and by 13% to 18% (p < 0.003) in parietal lobe gray matter (GM), but was not changed significantly in white matter and frontal lobe GM. In addition to lower NAA, AD patients had 29% smaller hippocampi and 11% less cortical GM than healthy subjects. Classification of AD and healthy subjects increased significantly from 89% accuracy using hippocampal volume alone to 95% accuracy using hippocampal volume and NAA together.
Conclusion: In addition to brain atrophy, NAA reductions occur in regions that are predominantly impacted by AD pathology.
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