Lack of Difference in Brain Hyperintensities Between Patients With Early Alzheimer's Disease and Control Subjects

doi:10.1001/archneur.1994.00540150054016

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Vol. 51 No. 3, March 1994

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Lack of Difference in Brain Hyperintensities Between Patients With Early Alzheimer's Disease and Control Subjects

Timo Erkinjuntti, MD, PhD; Fuqiang Gao, MD; Donald H. Lee, MD; Michael Eliasziw, PhD; Harold Merskey, DM; Vladimir C. Hachinski, MD, DSc(Med)

Arch Neurol. 1994;51(3):260-268.

Abstract

Objective
To rate magnetic resonance image signal hyperintensities inclearly defined white and deep gray matter areas in patientswith early Alzheimer's disease and controls.

Design
Prospective series. The National Institute for NeurologicalDisorders and Stroke—The Alzheimer's Disease and RelatedDisorders Association criteria for probable Alzheimer's disease.Blinded assessment.

Setting
University hospital, dementia study group.

Subjects
Thirty-four patients with Alzheimer's disease. Thirty-eightage-matched healthy community volunteers.

Measures
Frequency of hyperintensities in axial magnetic resonance images(1.5-T system) seen both in the proton density and T₂-weightedscans examined in vascular centrencephalon, centrum semiovale,watershed, periventricular, and subcortical white matter. Periventricularhyperintensities classification include caps, thin lining, andsmooth and irregular halo. Hyperintensities in other areas includesmall and large focal, focal confluent, and diffusely confluent.The hyperintensities were counted and rated using a five-pointscale and the Fazekas method.

Results
No difference in the ratings, frequency, or extent of the hyperintensitiesbetween patients with early Alzheimer's disease and controls.Majority of patients and controls had two or fewer hyperintensitiesand they were mostly small foci, caps, and thin linings. Thehyperintensities are associated with arterial hypertension,diabetes, cardiac disorder, and age in different combinations,but not with Alzheimer's disease.

Conclusion
Tiny hyperintensities on magnetic resonance images are frequentboth in patients with early Alzheimer's disease and in healthycontrols; most of the lesions are not related to brain ischemia.When age and vascular risk factors were taken into account,no difference between patients with early Alzheimer's diseaseand control subjects could be detected.

Author Affiliations

From the Departments of Clinical Neurological Sciences (Drs Erkinjuntti and Hachinski), Neuroradiology (Drs Gao and Lee), and Psychiatry (Dr Merskey), University of Western Ontario; The John P. Robarts Research Institute (Drs Erkinjuntti, Merskey, and Hachinski); Clinical Trials Resources Group, The John P. Robarts Research Institute (Dr Eliasziw); The London Psychiatric Hospital, London, Ontario (Dr Merskey); and the Department of Neurology, Memory Research Unit, University of Helsinki, Helsinki, Finland (Dr Erkinjuntti).

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