An MRI-Derived Definition of MCI-to-AD Conversion for Long-Term, Automati c Prognosis of MCI Patients

Alzheimer's disease (AD) and mild cognitive impairment (MCI), continue to be widely studied. While there is no consensus on whether MCIs actually "convert" to AD, the more important question is not whether MCIs convert, but what is the best such definition. We focus on automatic prognostication, nominally using only a baseline image brain scan, of whether an MCI individual will convert to AD within a multi-year period following the initial clinical visit. This is in fact not a traditional supervised learning problem since, in ADNI, there are no definitive labeled examples of MCI conversion. Prior works have defined MCI subclasses based on whether or not clinical/cognitive scores such as CDR significantly change from baseline. There are concerns with these definitions, however, since e.g. most MCIs (and ADs) do not change from a baseline CDR=0.5, even while physiological changes may be occurring. These works ignore rich phenotypical information in an MCI patient's brain scan and labeled AD and Control examples, in defining conversion. We propose an innovative conversion definition, wherein an MCI patient is declared to be a converter if any of the patient's brain scans (at follow-up visits) are classified "AD" by an (accurately-designed) Control-AD classifier. This novel definition bootstraps the design of a second classifier, specifically trained to predict whether or not MCIs will convert. This second classifier thus predicts whether an AD-Control classifier will predict that a patient has AD. Our results demonstrate this new definition leads not only to much higher prognostic accuracy than by-CDR conversion, but also to subpopulations much more consistent with known AD brain region biomarkers. We also identify key prognostic region biomarkers, essential for accurately discriminating the converter and nonconverter groups

Recent publications from the Alzheimer's Disease Neuroimaging Initiative: Reviewing progress toward improved AD clinical trials

INTRODUCTION: The Alzheimer's Disease Neuroimaging Initiative (ADNI) has continued development and standardization of methodologies for biomarkers and has provided an increased depth and breadth of data available to qualified researchers. This review summarizes the over 400 publications using ADNI data during 2014 and 2015. METHODS: We used standard searches to find publications using ADNI data. RESULTS: (1) Structural and functional changes, including subtle changes to hippocampal shape and texture, atrophy in areas outside of hippocampus, and disruption to functional networks, are detectable in presymptomatic subjects before hippocampal atrophy; (2) In subjects with abnormal β-amyloid deposition (Aβ+), biomarkers become abnormal in the order predicted by the amyloid cascade hypothesis; (3) Cognitive decline is more closely linked to tau than Aβ deposition; (4) Cerebrovascular risk factors may interact with Aβ to increase white-matter (WM) abnormalities which may accelerate Alzheimer's disease (AD) progression in conjunction with tau abnormalities; (5) Different patterns of atrophy are associated with impairment of memory and executive function and may underlie psychiatric symptoms; (6) Structural, functional, and metabolic network connectivities are disrupted as AD progresses. Models of prion-like spreading of Aβ pathology along WM tracts predict known patterns of cortical Aβ deposition and declines in glucose metabolism; (7) New AD risk and protective gene loci have been identified using biologically informed approaches; (8) Cognitively normal and mild cognitive impairment (MCI) subjects are heterogeneous and include groups typified not only by "classic" AD pathology but also by normal biomarkers, accelerated decline, and suspected non-Alzheimer's pathology; (9) Selection of subjects at risk of imminent decline on the basis of one or more pathologies improves the power of clinical trials; (10) Sensitivity of cognitive outcome measures to early changes in cognition has been improved and surrogate outcome measures using longitudinal structural magnetic resonance imaging may further reduce clinical trial cost and duration; (11) Advances in machine learning techniques such as neural networks have improved diagnostic and prognostic accuracy especially in challenges involving MCI subjects; and (12) Network connectivity measures and genetic variants show promise in multimodal classification and some classifiers using single modalities are rivaling multimodal classifiers. DISCUSSION: Taken together, these studies fundamentally deepen our understanding of AD progression and its underlying genetic basis, which in turn informs and improves clinical trial desig

Predictive models based on Support Vector Machines: whole-brain versus regional analysis of structural MRI in the Alzheimer’s disease

Decision-making systems trained on structural magnetic resonance imaging data of subjects affected by the Alzheimer's disease (AD) and healthy controls (CTRL) are becoming widespread prognostic tools for subjects with mild cognitive impairment (MCI). This study compares the performances of three classification methods based on support vector machines (SVMs), using as initial sets of brain voxels (ie, features): (1) the segmented grey matter (GM); (2) regions of interest (ROIs) by voxel-wise t-test filtering; (3) parceled ROIs, according to prior knowledge. The recursive feature elimination (RFE) is applied in all cases to investigate whether feature reduction improves the classification accuracy. We analyzed more than 600 AD Neuroimaging Initiative (ADNI) subjects, training the SVMs on the AD/CTRL dataset, and evaluating them on a trial MCI dataset. The classification performance, evaluated as the area under the receiver operating characteristic curve (AUC), reaches AUC = (88.9 ± .5)% in 20-fold cross-validation on the AD/CTRL dataset, when the GM is classified as a whole. The highest discrimination accuracy between MCI converters and nonconverters is achieved when the SVM-RFE is applied to the whole GM: with AUC reaching (70.7 ± .9)%, it outperforms both ROI-based approaches in predicting the AD conversion

Discriminative multi-task feature selection for multi-modality classification of Alzheimer’s disease

Recently, multi-task based feature selection methods have been used in multi-modality based classification of Alzheimer’s disease (AD) and its prodromal stage, i.e., mild cognitive impairment (MCI). However, in traditional multi-task feature selection methods, some useful discriminative information among subjects is usually not well mined for further improving the subsequent classification performance. Accordingly, in this paper, we propose a discriminative multitask feature selection method to select the most discriminative features for multi-modality based classification of AD/MCI. Specifically, for each modality, we train a linear regression model using the corresponding modality of data, and further enforce the group-sparsity regularization on weights of those regression models for joint selection of common features across multiple modalities. Furthermore, we propose a discriminative regularization term based on the intra-class and inter-class Laplacian matrices to better use the discriminative information among subjects. To evaluate our proposed method, we perform extensive experiments on 202 subjects, including 51 AD patients, 99 MCI patients, and 52 healthy controls (HC), from the baseline MRI and FDG-PET image data of the Alzheimer’s Disease Neuroimaging Initiative (ADNI). The experimental results show that our proposed method not only improves the classification performance, but also has potential to discover the disease-related biomarkers useful for diagnosis of disease, along with the comparison to several state-of-the-art methods for multi-modality based AD/MCI classification

Measuring cortical connectivity in Alzheimer's disease as a brain neural network pathology: Toward clinical applications

Objectives: The objective was to review the literature on diffusion tensor imaging as well as resting-state functional magnetic resonance imaging and electroencephalography (EEG) to unveil neuroanatomical and neurophysiological substrates of Alzheimer’s disease (AD) as a brain neural network pathology affecting structural and functional cortical connectivity underlying human cognition. Methods: We reviewed papers registered in PubMed and other scientific repositories on the use of these techniques in amnesic mild cognitive impairment (MCI) and clinically mild AD dementia patients compared to cognitively intact elderly individuals (Controls). Results: Hundreds of peer-reviewed (cross-sectional and longitudinal) papers have shown in patients with MCI and mild AD compared to Controls (1) impairment of callosal (splenium), thalamic, and anterior–posterior white matter bundles; (2) reduced correlation of resting state blood oxygen level-dependent activity across several intrinsic brain circuits including default mode and attention-related networks; and (3) abnormal power and functional coupling of resting state cortical EEG rhythms. Clinical applications of these measures are still limited. Conclusions: Structural and functional (in vivo) cortical connectivity measures represent a reliable marker of cerebral reserve capacity and should be used to predict and monitor the evolution of AD and its relative impact on cognitive domains in pre-clinical, prodromal, and dementia stages of AD. (JINS, 2016, 22, 138–163

Quantitative MRI Brain Studies in Mild Cognitive Impairment and Alzheimer's disease: A Methodological Review

Classifying and predicting Alzheimer's disease (AD) in individuals with memory disorders through clinical and psychometric assessment is challenging especially in Mild Cognitive Impairment (MCI) subjects. Quantitative structural Magnetic Resonance Imaging (MRI) acquisition methods in combination with Computer-Aided Diagnosis (CAD) are currently being used for the assessment AD. These acquisitions methods include: i) Voxel-based Morphometry (VBM), ii) volumetric measurements in specific Regions of Interest (ROIs), iii) cortical thickness measurements, iv) shape analysis and v) texture analysis. This review evaluates the aforementioned methods in the classification of cases into one of the following 3 groups: Normal Controls (NC), MCI and AD subjects. Furthermore, the performance of the methods is assessed on the prediction of conversion from MCI to AD. In parallel, it is also assessed which ROIs are preferred in both classification and prognosis through the different states of the disease. Structural changes in the early stages of the disease are more pronounced in the Medial Temporal Lobe (MTL) especially in the entorhinal cortex, whereas with disease progression both entorhinal cortex and hippocampus offer similar discriminative power. However, for the conversion from MCI subjects to AD, entorhinal cortex provides better predictive accuracies rather than other structures, such as the hippocampus