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Longitudinal Volumetric Computed Tomographic Analysis of Regional Brain Changes in Normal Aging and Alzheimer's Disease
Paula K. Shear, PhD;
Edith V. Sullivan, PhD;
Daniel H. Mathalon, PhD;
Kelvin O. Lim, MD;
Linda F. Davis;
Jerome A. Yesavage, MD;
Jared R. Tinklenberg, MD;
Adolf Pfefferbaum, MD
Arch Neurol. 1995;52(4):392-402.
Abstract
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Objective
This study used a semiautomated image analysis technique to quantify the rate and regional pattern of cerebrospinal fluid (CSF) volume changes in the computed tomographic brain examinations of healthy adults and patients with Alzheimer's disease (AD).
Design
Longitudinal, within-subject design, with statistical correction for longitudinal method error (eg, head repositioning effects).
Setting
Palo Alto (Calif) Department of Veterans Affairs Medical Center.
Patients and Other Participants
The 41 patients with AD were recruited from the Geriatric Psychiatry Research Unit and the National Institute of Mental Health Clinical Research Center of the Palo Alto Department of Veterans Affairs Medical Center. The 35 healthy control subjects were recruited from the local community.
Main Outcome Measures
Cerebrospinal fluid volumes estimated from computed tomographic scans.
Results
Even after accounting for an estimate of method error (eg, head positioning effects) across computed tomographic examinations, the patients with AD showed greater annual CSF volume increases than did the control group. This CSF volume enlargement was not uniform across brain regions of interest; rather, the patients with AD showed disproportionate volume increases in the ventricular system and the sylvian fissures. Greater CSF volume changes in the patients with AD were significantly associated with greater cognitive decline on the Mini-Mental State Examination. Furthermore, younger patients with AD showed more rapid progression on computed tomographic scans than did older patients.
Conclusions
The rate of CSF volume enlargement is region specific, with the most marked annual rate of change occurring in the ventricular system and the sylvian fissures. In addition, younger patients show more rapid progression in the ventricular and frontal sulcal brain regions of interest than do older patients.
Author Affiliations
From the Department of Psychiatry and Behavioral Sciences, Stanford (Calij) University School of Medicine (Drs Shear, Sullivan, Mathalon, Lim, Yesavage, Tinklenberg, and Pfefferbaum), and Psychiatry Service, Department of Veterans Affairs Medical Center (Drs Shear, Sullivan, Mathalon, Lim, Yesavage, Tinklenberg, and Pfefferbaum and Ms Davis), Palo Alto, Calif.
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