The Differentiation of Amnestic Type MCI from the Non-Amnestic Types by Structural MRI

Gábor Csukly, Enikő Sirály, Zsuzsanna Fodor, András Horváth, Pál Salacz, Zoltán Hidasi, Éva Csibri, Gábor Rudas, Ádám Szabó, Gábor Csukly, Enikő Sirály, Zsuzsanna Fodor, András Horváth, Pál Salacz, Zoltán Hidasi, Éva Csibri, Gábor Rudas, Ádám Szabó

Abstract

Introduction: While amnestic mild cognitive impairment (aMCI) and non-amnestic mild cognitive impairment (naMCI) are theoretically different entities, only a few investigations studied the structural brain differences between these subtypes of mild cognitive impairment. The aim of the study was to find the structural differences between aMCI and naMCI, and to replicate previous findings on the differentiation between aMCI and healthy controls.

Methods: Altogether 62 aMCI, naMCI, and healthy control subjects were included into the study based on the Petersen criteria. All patients underwent a routine brain MR examination, and a detailed neuropsychological examination.

Results: The sizes of the hippocampus, the entorhinal cortex and the amygdala were decreased in aMCI relative to naMCI and to controls. Furthermore the cortical thickness of the entorhinal cortex, the fusiform gyrus, the precuneus and the isthmus of the cingulate gyrus were significantly decreased in aMCI relative to naMCI and healthy controls. The largest differences relative to controls were detected for the volume of the hippocampus (18% decrease vs. controls) and the cortical thickness (20% decrease vs. controls) of the entorhinal cortex: 1.6 and 1.4 in terms of Cohen's d. Only the volume of the precuneus were decreased in the naMCI group (5% decrease) compared to the control subjects: 0.9 in terms of Cohen's d. Significant between group differences were also found in the neuropsychological test results: a decreased anterograde, retrograde memory, and category fluency performance was detected in the aMCI group relative to controls and naMCI subjects. Subjects with naMCI showed decreased letter fluency relative to controls, while both MCI groups showed decreased executive functioning relative to controls as measured by the Trail Making test part B. Memory performance in the aMCI group and in the entire sample correlated with the thickness of the entorhinal cortex and with the volume of the amygdala.

Conclusion: The amnestic mild cognitive impairment/non-amnestic mild cognitive impairment separation is not only theoretical but backed by structural imaging methods and neuropsychological tests. A better knowledge of the MCI subtypes can help to predict the direction of progression and create targeted prevention.

Keywords: MRI; amnestic; mild cognitive impairment; neuropsychological test; non-amnestic.

Figures

Figure 1
Figure 1
Between group differences in CNS structures and neuropsychological tests. Vertical bars represent group means, while error bars represent standard deviations. The horizontal lines over the vertical bars indicate significant between group differences after correction for multiple comparisons (p < 0.016). HC, healthy controls; aMCI, amnestic mild cognitive impairment; naMCI, non-amnestic mild cognitive impairment; CNS, central nervous system.
Figure 2
Figure 2
Correlation between short term memory performance as indexed by the Rey verbal learning test and the amygdala volume and the entorhinal cortex thickness in the study groups. Pearson correlations were significant (p < 0.05) in the amnestic MCI group and in the entire sample, while non-significant in the control and in the non-amnestic MCI groups. Rey verbal test total score on the vertical axes equals the sum of words in the first five trials. red line, regression line in the aMCI group; dashed line, regression line in the entire sample; MCI, mild cognitive impairment; r and p, Pearson correlation coefficient adjusted for age and corresponding level of significance in the aMCI group.

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