Freesurfer Vs. Manual Tracing: Detecting Future Cognitive Decline In Healthy Older Adults At-Risk For Alzheimer\u27s Disease

Alzheimer\u27s disease (AD) is a neurodegenerative pathological process that is thought to begin years prior to observable symptom onset. The hippocampus appears to be particularly vulnerable to the underlying brain pathology of AD. Hippocampal volume is a sensitive measure in predicting conversion from mild cognitive impairment to AD, but less is known regarding the use of hippocampal volume in asymptomatic individuals at risk for AD who eventually decline. The inconsistent findings may, in part, be due to the chosen method of hippocampal segmentation. FreeSurfer (FS) and manual tracings (MT) are two common segmentation techniques that have unique costs and benefits. The present study directly compared hippocampal volumes generated by FS and MT in a longitudinal design assessing cognitively healthy elders, with varying degree of risk for AD, over a 4.5-year period. After 4.5 years, 15 participants demonstrated cognitive decline, while 45 remained stable. The results suggest FS consistently produced larger hippocampal volumes than MT, but neither method distinguished between groups at baseline. Longitudinally, individuals who declined experienced a more progressive pattern of atrophy compared to those who remained stable. These data suggest that hippocampal volume over time may be a useful variable in determining cognitive change over time, with the addition of other known risk factors, such as genetic risk. This study also suggests that in presymptomatic individuals, MT may not provide added benefit over the use of the more cost-effective FS

Functional Resting State Connectivity in Individuals At-Risk for Alzheimer\u27s Disease

Resting state functional magnetic resonance imaging studies have examined the connectivity between the hippocampus (HIPP) and the posterior cingulate (PC) in individuals with Alzheimer\u27s disease (AD), mild cognitive impairment (MCI), and younger individuals at risk for AD. The present study aimed to examine the functional connectivity between these two memory structures and targets of AD neurodegeneration in cognitively intact elders at risk for AD (positive for ApolipoE protein (ε4) and family history of dementia), MCI, and healthy controls. Seeds and regions of interest were defined in the bilateral hippocampus and posterior cingulate, and the time courses were cross-correlated to generate a value of functional connectivity between two structures for comparisons across groups. Results indicate the presence of greater functional connectivity between the left HIPP and PC in healthy elders at risk compared to patients with MCI and healthy controls and a general reduction in functional connectivity between bilateral HIPP and PC in patients with MCI. This marker of increased functional connectivity, during the resting state of the brain, found in cognitively intact elders at risk compared to cognitively intact controls and symptomatic patients with MCI might be an important diagnostic tool to identify those most vulnerable for the development of AD

Semantic Memory Functional MRI and Cognitive Function After Exercise Intervention in Mild Cognitive Impairment

Mild cognitive impairment (MCI) is associated with early memory loss, Alzheimer\u27s disease (AD) neuropathology, inefficient or ineffective neural processing, and increased risk for AD. Unfortunately, treatments aimed at improving clinical symptoms or markers of brain function generally have been of limited value. Physical exercise is often recommended for people diagnosed with MCI, primarily because of its widely reported cognitive benefits in healthy older adults. However, it is unknown if exercise actually benefits brain function during memory retrieval in MCI. Here, we examined the effects of exercise training on semantic memory activation during functional magnetic resonance imaging (fMRI). Seventeen MCI participants and 18 cognitively intact controls, similar in sex, age, education, genetic risk, and medication use, volunteered for a 12-week exercise intervention consisting of supervised treadmill walking at a moderate intensity. Both MCI and control participants significantly increased their cardiorespiratory fitness by approximately 10% on a treadmill exercise test. Before and after the exercise intervention, participants completed an fMRI famous name discrimination task and a neuropsychological battery, Performance on Trial 1 of a list-learning task significantly improved in the MCI participants. Eleven brain regions activated during the semantic memory task showed a significant decrease in activation intensity following the intervention that was similar between groups (p-values ranged 0.048 to 0.0001). These findings suggest exercise may improve neural efficiency during semantic memory retrieval in MCI and cognitively intact older adults, and may lead to improvement in cognitive function. Clinical trials are needed to determine if exercise is effective to delay conversion to AD

Interactive Effects of Physical Activity and APOE-ε4 on BOLD Semantic Memory Activation in Healthy Elders

Evidence suggests that physical activity (PA) is associated with the maintenance of cognitive function across the lifespan. In contrast, the apolipoproteinE-ε4 (APOE-ε4) allele, a genetic risk factor for Alzheimer\u27s disease (AD), is associated with impaired cognitive function. The objective of this study was to examine the interactive effects of PA and APOE-ε4 on brain activation during memory processing in older (ages 65–85) cognitively intact adults. A cross-sectional design was used with four groups (n = 17 each): (1) Low Risk/Low PA; (2) Low Risk/High PA; (3) High Risk/Low PA; and (4) High Risk/High PA. PA level was based on self-reported frequency and intensity. AD risk was based on presence or absence of an APOE-ε4 allele. Brain activation was measured using event-related functional magnetic resonance imaging (fMRI) while participants performed a famous name discrimination task. Brain activation subserving semantic memory processing occurred in 15 functional regions of interest. High PA and High Risk were associated with significantly greater semantic memory activation (famous\u3eunfamiliar) in 6 and 3 of the 15 regions, respectively. Significant interactions of PA and Risk were evident in 9 of 15 brain regions, with the High PA/High Risk group demonstrating greater semantic memory activation than the remaining three groups. These findings suggest that PA selectively increases memory-related brain activation in cognitively intact but genetically at-risk elders. Longitudinal studies are required to determine whether increased semantic memory processing in physically active at-risk individuals is protective against future cognitive decline

Prediction of Longitudinal White Matter Change in Healthy Elderly Individuals

Diffusion Tensor Imaging (DTI) studies have shown that significant alteration in white matter (WM) integrity differentiates healthy older adults from persons with Mild Cognitive Impairment (MCI) and Alzheimer\u27s disease (AD). Most studies, however, have been cross-sectional and have not related longitudinal DTI changes to cognitive change. Here we report changes in WM integrity and cognition in healthy older adults over an 18-month interval. Sixty-seven cognitively intact elders underwent neuropsychological testing and DTI at baseline to follow-up on the Rey Auditory Verbal Learning Test (recall sum across trials 1-5, delayed recall) and Mattis Dementia Rating Scale-2. Declining participants (N=21) showed a minimum of 1 SD reduction on at least one cognitive measure, while Stable participants (N=46) showed comparable scores at each time point. WM regions-of-interest were derived from Freesurfer. Hierarchical linear regression was used to predict fractional anisotropy (FA) change in regions frequently identified in DTI studies of MCI and AD including transentorhinal cortex, temporal lobe, and posterior cingulate. Groups did not differ at baseline in age, cognition, FA, or WM volume. After controlling for age and baseline FA, cognitive status (Declining, Stable) predicted the baseline to 18-month reduction in FA in the right hippocampal gyrus (p=.004) and left fusi-form gyrus (p=.01) with a trend in the left middle temporal gyrus (p=.06). Future research should examine WM changes in other brain regions and determine whether DTI diffusivity measures are related to cognitive decline

FreeSurfer vs. Manual Tracing: Distinguishing Stable from Cognitively Declining Elders Using Prospectively Measured Hippocampal Volume

Objective: Alzheimer’s disease (AD) pathology is thought to begin years before symptom onset. Hippocampal volume is sensitive to age-related cognitive decline and conversion from MCI to AD. Measurement of hippocampal volumes has used either automated methods such as FreeSurfer (FS) or manual tracing (MT). We compared the ability of FS and MT in detecting baseline volume differences in cognitively intact older individuals who subsequently showed significant cognitive decline. Participants and Methods: Seventy-five cognitively intact elders underwent baseline and 18-month follow-up structural MRI scan and neuropsychological testing. Participants were classified as Declining (n=27) or Stable (n=48) based on the baseline to 18-month changes on a listlearning task and a measure of general cognitive functioning. A 2 (left, right) x 2 (anterior, posterior) x 2 (Declining, Stable) repeated measures ANOVA was conducted for both the MT and FS hippocampal volumes derived at baseline. Results: MT identified significantly smaller left and right hippocampal volumes and smaller anterior than posterior hippocampal volumes in Declining compared to Stable subjects. In contrast, no group differences in hippocampal volumes were observed using FS. Notably, MT included more subiculum and entorhinal cortex, while FS included more of the amygdala and the CA region of the hippocampus. Conclusions: MT was superior to FS for detecting prospective volumetric differences associated with cognitive decline in cognitively intact older participants. MT afforded more unique coverage of the anterior hippocampus than FS. The differences in regional coverage of the mesial temporal lobe between MT and FS may account for the different findings in discriminating Stable and Declining groups

Longitudinal Associations between Physical Activity, Cognitive Status, and Brain Function in Older Adults at Genetic Risk for Alzheimer’s Disease

The apolipoproteinE epsilon4 (APOE-?4) allele is associated with cognitive decline in old age and is a risk factor for Alzheimer\u27s disease (AD). Physical activity (P A) is associated with a reduced risk of incident cognitive impairment, particularly among APOE-?4 carriers. We recently reported greater semantic memory related brain activation in cognitively intact physically active (High P A) APOE-?4 carriers compared to physically inactive (Low PA) ?4 carriers and non-carriers (Smith et al., 2011). Here, we compared longitudinal changes in semantic memory-related brain activation in High PA and Low PA APOE-?4 carriers. Thirty-two older ?4 carriers completed neuropsychological testing and a fMRI semantic memory task (famous name discrimination) at baseline and after 18 months. All participants were cognitively intact at baseline and were classified as High PA (n = 16) or Low PA (n = 16) based on self-report. After 18 months, 5 of 16 High P A and 13 of 16 Low P A were classified as cognitively declining by at least 1 SD decrease in neurocognitive performance (Group difference, p = .011, Fisher\u27s exact test). A fROI analysis of the fMRI data and repeated measures ANOV As revealed significant Group by Time interactions for intensity of semantic memory-related activation. Significantly greater activation at baseline in the High PA group was attenuated over time (no change in Low P A) and resulted in no group differences at the 18-month follow-up. These findings suggest that greater P A at baseline is associated with greater cognitive stability over 18-months in APOE-?4 carriers and reduced neural activation during fame discrimination

Five-Year Changes in Brain Volume and Episodic Memory in Cognitively Intact Elders with and without an Apolipoprotein ε4 Allele

The apolipoprotein ε4 allele is a risk factor for Alzheimer\u27s disease. ε4 carriers diagnosed with AD or MCI exhibit an increased rate of atrophy on MRI relative to non-carriers. Few longitudinal studies have examined the rate of atrophy and cognitive change in older ε4 carriers who were cognitively intact at study entry. In this study, structural MRI and episodic memory testing were administered on two occasions separated by 5 years to 45 cognitively intact older adults, ages 65-90 years, divided into two groups: (1) carriers with one or both ε4 alleles (n=24) and (2) demographically-matched non-carriers (n=21). Longitudinal analysis of whole brain gray matter, whole brain white matter, and hippocampal volumes were derived from Freesurfer software. Analysis of variance indicated a significant group x time interaction for both left and right cortical gray matter (p\u27s \u3c .05; 2% decrease) and left hippocampus (p \u3c .001; 5.6% decrease); right hippocampus showed a marginal effect (p=.086; 4.9% decrease). In all instances, the ε4 group showed greater atrophy over the five-year interval than non-carriers. White matter brain volume significantly decreased over retest intervals (3.5%), but did not differ between groups. Over the same retest interval, the ε4 group also showed significantly greater decline than non-carriers on delayed word recall and percent retention on a list-learning task. These data suggest that the presence of an ε4 allele carries an increased risk for cortical gray matter and hippocampal atrophy and memory loss among older participants who were cognitively intact at study entry

Lifestyle and Genetic Contributions to Cognitive Decline and Hippocampal Structure and Function in Healthy Aging

Background: Engagement in cognitively stimulating activities (CA) and leisure time physical activity (PA) have been associated with maintaining cognitive performance and reducing the likelihood of cognitive decline in older adults. However, neural mechanisms underlying protective effects of these lifestyle behaviors are largely unknown. In the current study, we investigated the effect of self-reported PA and CA on hippocampal volume and semantic processing activation during a fame discrimination task, as measured by functional magnetic resonance imaging (fMRI). We also examined whether possession of the apolipoprotein E (APOE) ?4 allele could moderate the effect of PA or CA on hippocampal structure or function. Methods: Seventy-eight healthy, cognitively intact older adults underwent baseline neuropsychological assessment, hippocampal volume measurement via manually-traced structural MRI, and task-activated fMRI. Results: After 18 months, 27 participants declined by one standard deviation or more on follow-up neuropsychological testing. Logistic regression analyses revealed that CA alone or in combination with baseline hippocampal structure or functional activity did not predict the probability of cognitive decline. In contrast, PA interacted with APOE 4 status such that engagement in PA reduced the risk of cognitive decline in APOE 4 carriers only. Furthermore, the benefits of PA appeared to diminish with reduced functional activity or volume in the hippocampus. Conclusions: Our findings suggest that increased leisure time PA is associated with reduced probability of cognitive decline in persons who are at high risk for AD. The beneficial effects of PA in this group may be related to enhancement of the functional and structural integrity of the hippocampus

Prediction of Cognitive Decline in Healthy Older Adults using fMRI

Few studies have examined the extent to which structural and functional MRI, alone and in combination with genetic biomarkers, can predict future cognitive decline in asymptomatic elders. This prospective study evaluated individual and combined contributions of demographic information, genetic risk, hippocampal volume, and fMRI activation for predicting cognitive decline after an 18-month retest interval. Standardized neuropsychological testing, an fMRI semantic memory task (famous name discrimination), and structural MRI (sMRI) were performed on 78 healthy elders (73% female; mean age = 73 years, range = 65 to 88 years). Positive family history of dementia and presence of one or both apolipoprotein E (APOE) ε4 alleles occurred in 51.3% and 33.3% of the sample, respectively. Hippocampal volumes were traced from sMRI scans. At follow-up, all participants underwent a repeat neuropsychological examination. At 18 months, 27 participants (34.6%) declined by at least 1 SD on one of three neuropsychological measures. Using logistic regression, demographic variables (age, years of education, gender) and family history of dementia did not predict future cognitive decline. Greater fMRI activity, absence of an APOE ε4 allele, and larger hippocampal volume were associated with reduced likelihood of cognitive decline. The most effective combination of predictors involved fMRI brain activity and APOE ε4 status. Brain activity measured from task-activated fMRI, in combination with APOE ε4 status, was successful in identifying cognitively intact individuals at greatest risk for developing cognitive decline over a relatively brief time period. These results have implications for enriching prevention clinical trials designed to slow AD progression