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Shane MacKay, MD; Dieter J. Meyerhoff, Dr rer nat; Jean-Marc Constans, MD; David Norman, MD; George Fein, PhD; Michael W. Weiner, MD

Arch Neurol. 1996;53(2):167-174.

Abstract
Objective
To use ¹H magnetic resonance spectroscopic imaging to study differences in neuron density (N-acetylaspartate [NAA]), membrane phospholipid metabolites (choline [Cho]), and creatine-containing metabolites (creatine plus phosphocreatine [Cr]) in subjects with Alzheimer's disease (AD), with subcortical ischemic vascular dementia (SIVD), and elderly controls.

Design
Cross-sectional, between groups.

Setting
A Veterans Affairs medical center and university memory clinic.

Participants
Forty elderly subjects with AD (n=14), with SIVD (n=8), and elderly controls (n=18).

Main Outcome Measures:

We used ¹H magnetic resonance spectroscopic imaging to acquire spectra from a 80x100x17-mm volume superior to the lateral ventricles. Spectra were analyzed from voxels in anterior, medial, and posterior gray and white matter using nuclear magnetic resonance-1 and the results were compared between groups using repeated measures analysis of variance (ANOVA), Tukey's test, and individual Student's t tests.

Results
Using ANOVA, significantly lower levels of NAA/Cho and NAA/Cr and significantly higher levels of Cho/Cr were observed across both gray and white matter voxels in subjects with AD. Using individual Student's t tests, a significantly lower level of NAA/Cho and a higher level of Cho/Cr were observed in the posterior gray matter in subjects with AD. Using ANOVA in subjects with SIVD, significantly lower gray and white matter NAA/Cr levels were observed. Using Tukey's test, the NAA/Cr level was significantly lower in frontal white matter voxels in subjects with SIVD compared with controls.

Conclusions
Our findings in subjects with AD suggest neuron loss in gray matter, axon loss in white matter, and altered Cho metabolism in posterior brain regions. Our findings in subjects with SIVD are consistent with higher levels of creatine-containing metabolites and/or lower levels of NAA in frontal white matter.

Author Affiliations
From the Magnetic Resonance Spectroscopy Unit, Department of Veterans Affairs Medical Center (Drs MacKay, Meyerhoff, and Weiner); Jacques Theron et Patrick Courtheaux Centre Hospitalier Regional University, Paris, France (Dr Constans); and the Departments of Radiology (Drs Meyerhoff, Norman, and Weiner), Medicine (Dr Weiner), and Psychiatry (Drs MacKay, Fein, and Weiner), University of California at San Francisco.

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