Cited by 290Dementia and Cognitive Impairment ResearchAlzheimer's disease research and treatmentsMemory and Neural Mechanisms

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Hippocampal subfield volumetry in mild cognitive impairment, Alzheimer's disease and semantic dementia

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La Joie, Renaud, Perrotin, Audrey, de La Sayette, Vincent, Egret, Stéphanie, Doeuvre, Loïc, Belliard, Serge, Eustache, Francis, Desgranges, Béatrice, Chételat, Gaël·2013·NeuroImage: Clinical

Abstract

BACKGROUND: Hippocampal atrophy is a well-known feature of Alzheimer's disease (AD), but sensitivity and specificity of hippocampal volumetry are limited. Neuropathological studies have shown that hippocampal subfields are differentially vulnerable to AD; hippocampal subfield volumetry may thus prove to be more accurate than global hippocampal volumetry to detect AD. METHODS: CA1, subiculum and other subfields were manually delineated from 40 healthy controls, 18 AD, 17 amnestic Mild Cognitive Impairment (aMCI), and 8 semantic dementia (SD) patients using a previously developed high resolution MRI procedure. Non-parametric group comparisons and receiver operating characteristic (ROC) analyses were conducted. Complementary analyses were conducted to evaluate differences of hemispheric asymmetry and anterior-predominance between AD and SD patients and to distinguish aMCI patients with or without β-amyloid deposition as assessed by Florbetapir-TEP. RESULTS: Global hippocampi were atrophied in all three patient groups and volume decreases were maximal in the CA1 subfield (22% loss in aMCI, 27% in both AD and SD; all p < 0.001). In aMCI, CA1 volumetry was more accurate than global hippocampal measurement to distinguish patients from controls (areas under the ROC curve = 0.88 and 0.76, respectively; p = 0.05) and preliminary analyses suggest that it was independent from the presence of β-amyloid deposition. In patients with SD, whereas the degree of CA1 and subiculum atrophy was similar to that found in AD patients, hemispheric and anterior-posterior asymmetry were significantly more marked than in AD with greater involvement of the left and anterior hippocampal subfields. CONCLUSIONS: The findings suggest that CA1 measurement is more sensitive than global hippocampal volumetry to detect structural changes at the pre-dementia stage, although the predominance of CA1 atrophy does not appear to be specific to AD pathophysiological processes.

Overview

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TL;DR

Manual hippocampal subfield volumetry in 40 controls, 17 aMCI, 18 AD, and 8 semantic dementia patients showed maximal atrophy in CA1 across patient groups. CA1 volume was more accurate than global hippocampal volume for distinguishing aMCI from controls, but CA1 predominance was not specific to AD pathophysiology.

Key findings

  • Global hippocampal volume was reduced in all patient groups: −12% in aMCI, −22% in AD, and −17% in SD. CA1 showed the largest losses: −22% in aMCI and −27% in both AD and SD (all p < 0.001).
  • In aMCI, CA1 volumetry discriminated patients from controls better than global hippocampal volume (AUC = 0.88 [0.78–0.98] vs. 0.76 [0.60–0.93], p = 0.05). In AD vs. controls, no subfield outperformed the whole hippocampus (whole hippocampus AUC = 0.91 [0.78–1]; CA1 = 0.92 [0.85–0.99]).
  • SD showed greater hemispheric asymmetry than AD for the whole hippocampus (p = 0.001), subiculum (p = 0.02), and other subfields (p = 0.01), with a trend for CA1 (p = 0.06); SD also had a lower anterior–posterior index for whole hippocampus, CA1, and subiculum, indicating anterior-predominant atrophy.
  • Among 15 aMCI patients with Florbetapir PET, Aβ-positive aMCI had lower CA1 (p < 0.001), subiculum (p = 0.01), and hippocampal volumes (p = 0.01) than controls, while Aβ-negative aMCI only showed lower CA1 volume (p = 0.04); direct Aβ-positive vs. Aβ-negative comparisons were not significant (all p > 0.25).

Methods

  • Cross-sectional study of 83 right-handed participants: 40 healthy controls, 17 aMCI, 18 AD, and 8 SD patients.
  • CA1, subiculum, and “other” subfields (CA2–CA3–CA4 plus dentate gyrus) were manually delineated on high-resolution 3-Tesla MRI slices perpendicular to the hippocampal long axis; volumes were TIV-normalized and converted to age- and gender-adjusted W-scores.
  • Non-parametric group comparisons (Kruskal–Wallis, Mann–Whitney U), ROC/AUC analyses, asymmetry and anterior–posterior indices, and Florbetapir PET analyses in 18 AD and 15 aMCI patients using a neocortical SUVr threshold of 1.1.

Limitations

  • Stated: patient groups were relatively small, especially when aMCI was split by Aβ status; Aβ-related findings were considered preliminary. The paper also states that subfield volumetry provides approximations based on anatomical landmarks, that protocols differ across studies without direct comparison to neuropathological gold standard, and that high-resolution scans are prone to motion artifacts.
  • Stated: the absence of significant AD vs. SD differences could be due to lack of statistical power.
  • Evident: manual delineation was performed by a single rater, and the text does not report inter-rater or test–retest reliability metrics for the present sample; the design is cross-sectional, so diagnostic/prognostic accuracy over time is not established.

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Integrity signals

Registry

Crossref · 10.1016/j.nicl.2013.08.007

Cites

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Figures

Fig. 1 Illustration of hippocampal subfield delineation. Three regions were manually delineated within each hippocampus: CA1 (blue), subiculum (green) and other (pink). Subfields were delineated on 9 slices on average; for the purpose of illustration, examples are displayed on three slices along the anterior–posterior axis of the hippocampus. Images correspond to a healthy control (left), a patient with Alzheimer's disease (middle) and a patient with semantic dementia (right). Images are in the neurological convention (right is right). Additional examples are available in Supplementary Fig. 1. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)
Fig. 1 Illustration of hippocampal subfield delineation. Three regions were manually delineated within each hippocampus: CA1 (blue), subiculum (green) and other (pink). Subfields were delineated on 9 slices on average; for the purpose of illustration, examples are displayed on three slices along the anterior–posterior axis of the hippocampus. Images correspond to a healthy control (left), a patient with Alzheimer's disease (middle) and a patient with semantic dementia (right). Images are in the neurological convention (right is right). Additional examples are available in Supplementary Fig. 1. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)CC BY-NC-SA · PubMed Central
Fig. 2 Between-group comparisons of hippocampal measurements. Abbreviations: HC = healthy controls; aMCI = amnestic Mild Cognitive Impairment; AD = Alzheimer's disease; SD = semantic dementia. Volumes are expressed as W-scores (i.e. age- and gender-adjusted Z-scores as compared to the control group). Kruskal–Wallis ANOVA was significant for all regions and post-hoc tests were performed with the Mann–Whitney test (t: p < 0.10; *: p < 0.05; **: p < 0.01; ***: p < 0.001).
Fig. 2 Between-group comparisons of hippocampal measurements. Abbreviations: HC = healthy controls; aMCI = amnestic Mild Cognitive Impairment; AD = Alzheimer's disease; SD = semantic dementia. Volumes are expressed as W-scores (i.e. age- and gender-adjusted Z-scores as compared to the control group). Kruskal–Wallis ANOVA was significant for all regions and post-hoc tests were performed with the Mann–Whitney test (t: p < 0.10; *: p < 0.05; **: p < 0.01; ***: p < 0.001).CC BY-NC-SA · PubMed Central
Fig. 3 ROC Curve for CA1 and total hippocampal volume in aMCI patients versus HC. ROC curves for CA1 (blue) and total hippocampal volume (gray) in the comparison between healthy controls (HC) and patients with amnestic Mild Cognitive Impairment (aMCI). The area under the curve (AUC) is significantly higher (p = 0.05) for CA1 (AUC = 0.881) than for total hippocampal volume (0.763). (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)
Fig. 3 ROC Curve for CA1 and total hippocampal volume in aMCI patients versus HC. ROC curves for CA1 (blue) and total hippocampal volume (gray) in the comparison between healthy controls (HC) and patients with amnestic Mild Cognitive Impairment (aMCI). The area under the curve (AUC) is significantly higher (p = 0.05) for CA1 (AUC = 0.881) than for total hippocampal volume (0.763). (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)CC BY-NC-SA · PubMed Central
Fig. 4 CA1 atrophy in aMCI patients classified as Aβ-positive or Aβ-negative according to their neocortical Florbetapir SUVr. Abbreviations: HC = healthy controls; Aβ + aMCI = β-amyloid—positive patients with amnestic Mild Cognitive Impairment; Aβ − aMCI = β-amyloid—negative patients with amnestic Mild Cognitive Impairment. For this analysis, a subsample of 28 age-, gender-, and education-matched HC was selected. Kruskal–Wallis ANOVA was significant (p = 0.001) and post-hoc tests were performed with the Mann–Whitney test (*: p < 0.05; ***: p < 0.001).
Fig. 4 CA1 atrophy in aMCI patients classified as Aβ-positive or Aβ-negative according to their neocortical Florbetapir SUVr. Abbreviations: HC = healthy controls; Aβ + aMCI = β-amyloid—positive patients with amnestic Mild Cognitive Impairment; Aβ − aMCI = β-amyloid—negative patients with amnestic Mild Cognitive Impairment. For this analysis, a subsample of 28 age-, gender-, and education-matched HC was selected. Kruskal–Wallis ANOVA was significant (p = 0.001) and post-hoc tests were performed with the Mann–Whitney test (*: p < 0.05; ***: p < 0.001).CC BY-NC-SA · PubMed Central

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  • The paper relies on this without support.

    Healthy controls are free of preclinical Alzheimer's disease pathology.

    “HC were recruited from the community and performed in the normal range on a neuropsychological examination assessing multiple domains of cognition including episodic and semantic memory, executive and visuo-spatial functions, language and praxis.”
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Metadata

Authors
La Joie, R., Perrotin, A., de La Sayette, V., Egret, S., Doeuvre, L., Belliard, S., Eustache, F., Desgranges, B., & Chételat, G.
Affiliations
Inserm (FR)
Corresponding author
Chételat, Gaël
Venue
NeuroImage: Clinical
Publisher
Elsevier BV
Published
2013
Volume
3
Pages
155-162
ISSN
2213-1582 (ISSN-L)
OpenAlex
W2060796157
Cited by
290
References
57
Citations by year
2026: 16 · 2025: 20 · 2024: 24 · 2023: 18 · 2022: 26 · 2021: 28 · 2020: 31 · 2019: 24 · 2018: 24 · 2017: 19 · 2016: 25 · 2015: 22 · 2014: 13
FWCI
14.22
Type
journal article
Language
en
Open access
Locations
  • NeuroImage Clinical (publishedVersion, cc-by-nc-sa)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-sa)
  • PubMed Central (publishedVersion, cc-by-nc-sa)
  • PubMed (publishedVersion)
  • HAL (submittedVersion, other-oa)
Funders
  • Fondation Plan Alzheimer (Alzheimer Plan 2008–2012)
  • Programme Hospitalier de Recherche Clinique (PHRC National 2011)
  • Agence Nationale de la Recherche (ANR LONGVIE 2007)
  • Région Basse Normandie, and Institut National de la Santé et de la Recherche Médicale (INSERM)
  • Inserm-Liliane Bettencourt School (MD–PhD Program)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Alzheimer's disease research and treatments
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Memory and Neural Mechanisms
Keywords
hippocampal subfields, hippocampal volumetry, CA1, subiculum, mild cognitive impairment, Alzheimer's disease, semantic dementia, hippocampal atrophy, amyloid-beta deposition, hemispheric lateralization

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