title: Different patterns of N-acetylaspartate loss in subcortical ischemic vascular dementia and AD.
abstract: OBJECTIVE
  1) To determine the regional pattern of reduced N-acetylaspartate (NAA) in subcortical ischemic vascular dementia (SIVD); 2) to explore the relationship between NAA reduction and subcortical vascular disease; and 3) to test if MR spectroscopic imaging (MRSI) in combination with structural MRI improves differentiation between SIVD and Alzheimer disease (AD).
  
  
  METHODS
  Thirteen patients with SIVD (71 +/- 8 years old) and 43 patients with AD of comparable age and dementia severity were studied using MRSI and MRI. Patients were compared to 52 cognitively normal subjects with and without lacunes.
  
  
  RESULTS
  Compared to controls, patients with SIVD had lower NAA by 18% (p < 0.001) in frontal cortex and by 27% (p < 0.003) in parietal cortex, but no significant NAA reduction in white matter and medial temporal lobe. Compared to patients with AD, patients with SIVD had lower NAA by 13% (p < 0.02) in frontal cortex and by 20% (p < 0.002) in left parietal cortex. Cortical NAA decreased in SIVD with increasing white matter lesions (r = 0.54, p < 0.02) and number of lacunes (r = 0.59, p < 0.02). Thalamic lacunes were associated with greater NAA reduction in frontal cortex than were lacunes outside the thalamus (p < 0.02) across groups, after adjusting for cognitive impairments. Adding parietal NAA to MRI-derived hippocampal atrophy improved separation between SIVD and AD (p = 0.02) from 79 to 89%.
  
  
  CONCLUSIONS
  These results emphasize the importance of cortical dysfunction as a factor in SIVD and indicate a characteristic pattern of metabolite change that might serve as a basis for improved diagnosis.
authors.affiliation: Magnetic Resonance Unit, DVA Medical Center San Francisco, CA 94121, USA. nschuff@itsa.ucsf.edu
authors.forename: N
authors.initials: N
authors.lastname: Schuff
authors.forename: A A
authors.initials: AA
authors.lastname: Capizzano
authors.forename: A T
authors.initials: AT
authors.lastname: Du
authors.forename: D L
authors.initials: DL
authors.lastname: Amend
authors.forename: J
authors.initials: J
authors.lastname: O'Neill
authors.forename: D
authors.initials: D
authors.lastname: Norman
authors.forename: W J
authors.initials: WJ
authors.lastname: Jagust
authors.forename: H C
authors.initials: HC
authors.lastname: Chui
authors.forename: J H
authors.initials: JH
authors.lastname: Kramer
authors.forename: B R
authors.initials: BR
authors.lastname: Reed
authors.forename: B L
authors.initials: BL
authors.lastname: Miller
authors.forename: K
authors.initials: K
authors.lastname: Yaffe
authors.forename: M W
authors.initials: MW
authors.lastname: Weiner
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000378:metabolism*; D001224:Aspartic Acid / Q000031:analogs & derivatives* / Q000032:analysis / Q000378:metabolism*; D001921:Brain / Q000378:metabolism / Q000473:pathology; D015140:Dementia, Vascular / Q000175:diagnosis* / Q000378:metabolism*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D012016:Reference Values
chemical_list: D001224:Aspartic Acid; C000179:N-acetylaspartate