Cited by 937Dementia and Cognitive Impairment ResearchAlzheimer's disease research and treatmentsCancer-related cognitive impairment studies

The DOI matches its Crossref record; 34 of the 34 references it cites were found in a registry or an index; 1 of the 21 sources its claims cite were checked for support.

Rates of hippocampal atrophy correlate with change in clinical status in aging and AD

Open access

Abstract

BACKGROUND: The cognitive continuum in the elderly population can be conceptually divided into those who are functioning normally (control subjects), those with a mild cognitive impairment (MCI), and those with probable AD. OBJECTIVES: To test the hypothesis that the annualized rates of hippocampal atrophy differ as a function of both baseline and change in clinical group membership (control, MCI, or AD). METHODS: The authors identified 129 subjects from the Mayo Clinic AD Research Center/AD Patient Registry who met established criteria for normal control subjects, MCI, or probable AD, both at entry and at the time of a subsequent clinical follow-up evaluation 3 +/- 1 years later. Each subject underwent an MRI examination of the head at the time of the initial assessment and at follow-up clinical assessment; the annualized percentage change in hippocampal volume was computed. Subjects who were classified as controls or patients with MCI at baseline could either remain cognitively stable or could decline to a lower functioning group over the period of observation. RESULTS: The annualized rates of hippocampal volume loss for each of the three initial clinical groups decreased progressively in the following order: AD > MC > control. Within the control and MCI groups, those who declined had a significantly greater rate of volume loss than those who remained clinically stable. The mean annualized rates of hippocampal atrophy by follow-up clinical group were: control-stable 1.73%, control-decliner 2.81%, MCI-stable 2.55%, MCI-decliner 3.69%, AD 3. 5%. CONCLUSION: Rates of hippocampal atrophy match both baseline cognitive status and the change in cognitive status over time in elderly persons who lie along the cognitive continuum from normal to MCI to AD.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

In 129 Mayo ADPR/ADRC subjects with baseline and 3 ± 1 year follow-up, annualized hippocampal atrophy rates increased across control, MCI, and AD groups and were greater in clinical decliners than in stable subjects within the control and MCI groups. The results support the hypothesis that rates of hippocampal atrophy match both baseline cognitive status and change in cognitive status over time.

Key findings

  • Annualized hippocampal volume loss by initial clinical group was control −1.9 ± 1.1%, MCI −3.0 ± 1.6%, and AD −3.5 ± 1.8%; control vs MCI and control vs AD differences were significant at p < 0.001.
  • By follow-up clinical group, mean annualized rates were control-stable −1.7 ± 0.9%, control-decliner −2.8 ± 1.7%, MCI-stable −2.5 ± 1.5%, MCI-decliner −3.7 ± 1.5%, and AD −3.5 ± 1.8%; control-stable vs control-decliner p = 0.03 and MCI-stable vs MCI-decliner p = 0.03.
  • Baseline hippocampal volume decreased progressively from control to MCI to AD, with all three baseline group differences significant at p < 0.000; median normal percentiles were 41 for control, 11 for MCI, and 2 for AD.
  • Over follow-up, 10 of 58 controls (17%) declined to MCI or probable AD, and 18 of 43 MCI subjects (42%) declined to AD.

Methods

  • The study identified 129 subjects from the Mayo Clinic AD Research Center/AD Patient Registry who met criteria for normal control, MCI, or probable AD at entry and at a follow-up clinical evaluation 3 ± 1 years later; subjects with symptoms felt unrelated to AD, such as stroke or depression, were excluded.
  • Each subject underwent MRI at baseline and follow-up; hippocampal volumes were manually traced, and annualized percentage change was computed as scan 2 volume minus scan 1 volume, divided by scan 1 volume, divided by years between scans, × 100.
  • Baseline hippocampal volumes were normalized for head size, age, and sex using W scores from a normal elderly control database; comparisons used two-way ANOVA on ranked data by baseline clinical group and stable/decliner status, followed by rank sum tests.

Limitations

  • The paper states that dichotomizing control and MCI subjects into stable vs decliner is crude because cognitive change is continuous, that the rates are a linear fit to only two time points and may not be linear, and that requiring two artifact-free MRI studies 2–4 years apart may exclude rapidly progressive dementia patients and therefore underestimate atrophy in decliner groups.
  • The paper notes that the number of control decliners was small (n = 10), that diagnostic utility in predicting future AD will likely be limited by inter-group overlap, and that whether atrophy rate adds predictive power beyond baseline hippocampal volume was not formally addressed.
  • Evident from the text: this is an observational, single-center clinical cohort study using clinical diagnostic classifications without pathologic confirmation, and the authors acknowledge that control-decliner is a “misnomer” because such individuals were likely presymptomatic AD at baseline.

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Integrity signals

Registry

Crossref · 10.1212/wnl.55.4.484

Cites

34 of 34 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

38 Own result · 15 Not checked yet · 14 Own interpretation · 12 Own method · 1 Supported

Verify all 20 references — free account

Show all 50 claims

  • It may state two separate claims as one. 10
  • Probably not a substantial claim. 24
30 of 30
  • The paper relies on this without support.

    The transition from normal cognition to Alzheimer's disease is gradual.

    “The transition from normal cognition to Alzheimer's disease (AD) is gradual.”
  • The paper relies on this without support.

    Patients who develop clinically evident Alzheimer's disease pass through a transitional period during which they experience declining cognitive abilities relative to age mates.

    “Patients who develop clinically evident AD pass through a transitional period during which they experience declining cognitive abilities relative to age mates.”
  • The paper relies on this without support.

    No single test is accepted for defining discrete ranges within the cognitive continuum.

    “As no single test is accepted for defining discrete ranges within the cognitive continuum, we chose to use the designations of control, MCI, and AD which are ultimately clinical judgments that are derived from a number of different factors.”
  • The paper relies on this without support.

    Change in cognition over time occurs as a continuous rather than a step-wise function.

    “We also acknowledge that dichotomization of the control and MCI groups into those who remained stable vs decliners is a crude way to define change in cognition because the change in cognition over time occurs as a continuous rather than a step-wise function.”
  • The paper relies on this without support.

    The largest volume loss over time should occur in patients who were the most rapid clinical decliners.

    “The reported rates of atrophy in the decliner groups may therefore be underestimated, because the largest volume loss over time should occur in patients who were the most rapid clinical decliners.”
  • The paper relies on this without support.

    The pathologic progression leading to AD may extend over decades.

    “In any individual patient the pathologic progression leading to AD may extend over decades.”
  • The paper relies on this without support.

    The measured change in hippocampal volume in every elderly individual should be ≤0.

    “Theoretically the measured change in hippocampal volume in every elderly individual should be ≤ 0, indicating either no change or volume loss over time.”
  • The paper relies on this without support.

    To our knowledge this is the first study which describes the rates of hippocampal atrophy in MCI patients.

    “To our knowledge this is the first study which describes the rates of hippocampal atrophy in MCI patients.”
  • The paper relies on this without support.

    Prior studies on rates of hippocampal atrophy have not distinguished stable controls from control decliners.

    “Prior studies on rates of hippocampal atrophy have not distinguished stable controls from control decliners.”
9 of 9

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Metadata

Authors
Jack, C. R., Petersen, R. C., Xu, Y., O’Brien, P. C., Smith, G. E., Ivnik, R. J., Boeve, B. F., Tangalos, E. G., & Kokmen, E.
Affiliations
Mayo Clinic (US)
Venue
Neurology
Published
2000-08-22
Volume
55
Issue
4
Pages
484-490
ISSN
  • 0028-3878 (ISSN-L)
  • 1526-632X
OpenAlex
W2044367669
Cited by
937
References
34
Citations by year
2026: 26 · 2025: 34 · 2024: 33 · 2023: 23 · 2022: 40 · 2021: 47 · 2020: 38 · 2019: 22 · 2018: 31 · 2017: 32 · 2016: 32 · 2015: 21 · 2014: 31 · 2013: 41 · 2012: 42
FWCI
20.00
Type
journal article
Language
en
Open access
Locations
  • Neurology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute on Aging (AG-08031, P30AG008031, AG-06786, U01AG006786, R01AG011378, AG-11378, R37AG011378, P50AG016574)
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
  • Health Sciences › Medicine › Oncology › Cancer-related cognitive impairment studies
Keywords
hippocampal atrophy, Alzheimer's disease, mild cognitive impairment, cognitive decline, cognitive continuum, aging, brain MRI
MeSH terms
Aged, Aged, 80 and over, Aging, Alzheimer Disease, Apolipoproteins E, Atrophy, Cognition Disorders, Female, Follow-Up Studies, Hippocampus, Humans, Longitudinal Studies, Magnetic Resonance Imaging, Male, Middle Aged, Predictive Value of Tests, Disease Progression

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